336411357-6-4-2026-18-AS-RORN-DUVQ2T-20260609114740

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336411357
Report Date: 06/04/2026
Date Signed: 06/04/2026 12:15:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20241104082248

FACILITY NAME:	SLB INC CALLE PRIMA		FACILITY NUMBER:	336411357
ADMINISTRATOR:	COTADELA BALATBAT		FACILITY TYPE:	735
ADDRESS:	21650 CALLE PRIMA		TELEPHONE:	(951) 776-0424
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	6	CENSUS: 5	DATE:	06/04/2026
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	COTADELA BALATBAT		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff yells at residents.

INVESTIGATION FINDINGS:

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On June 4, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. LPA met with the Administrator (A1), Cotadela Balatbat, and explained the purpose of the visit.

The complaint investigations consisted of the following. On June 4, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 06/01/26) and the Client Roster. The Department reviewed and collected documents for Resident 1 (R1), including the Admission Agreement, the physician's Report, and the facility note dated 05/22/2025, and staff training on the client's personal rights. On 11/13/2024, the Department interviewed the Administrator (A1), three staff members (S1-S3), and three clients (C1-C3). On 06/04/2026, the department interviewed the Administrator (A1), the Executive Director (ED), and three staff members (S4-S6). During today's investigation, the department found that the client C1 moved out of the facility on 05/22/2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20241104082248

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SLB INC CALLE PRIMA	FACILITY NUMBER: 336411357
	VISIT DATE: 06/04/2026

NARRATIVE

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Allegation #1: Staff yells at residents.

The complaint alleged that the staff member (S1) yells at the client. On November 13, 2024, the department interviewed the Administrator (A1), who denied the allegation and stated that staff members do not yell at any client in care. The Administrator also stated that staff receive quarterly training on clients' rights. On November 13, 2024, the department interviewed three staff members (S1-S3), all of whom denied ever yelling at clients or witnessing any staff member yell at a client. They also stated that S1 has a loud voice but is not considered to be yelling when speaking. On the same day, the department interviewed three clients (C1-C3), all of whom denied ever being yelled at by S1.

On June 4, 2026, the department interviewed the Executive Director (ED), who denied the allegation and noted that staff member (S1) sometimes speaks in a deep voice. People might think S1 is yelling, but that’s not the case. The ED also stated that clients have never complained that S1 yells at them. On the same day, the department interviewed the Administrator (A1), who also denied the allegation and stated that S1 is the worker here. The department also interviewed three staff members (S4-S6), all of whom denied ever yelling at clients or witnessing other staff members do so. They stated that S1 has a loud tone of voice but never yells. During the investigation, the department reviewed the facility's annual staff training on clients’ personal rights.

Report Continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20241104082248

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: SLB INC CALLE PRIMA	FACILITY NUMBER: 336411357
	VISIT DATE: 06/04/2026

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated.

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to Administrator Cotadela Balatbat.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/04/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026

LIC9099 (FAS) - (06/04)

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