<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412337
Report Date: 06/13/2023
Date Signed: 06/13/2023 10:07:54 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/02/2021 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210602131848
FACILITY NAME:WHITE HOME, THEFACILITY NUMBER:
336412337
ADMINISTRATOR:DEBORAH STANGELFACILITY TYPE:
735
ADDRESS:26245 WHITE AVETELEPHONE:
(951) 325-8536
CITY:HEMETSTATE: CAZIP CODE:
92548
CAPACITY:4CENSUS: 4DATE:
06/13/2023
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Sandra Ascencio- CaregiverTIME COMPLETED:
10:20 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Client was unlawfully evicted.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to deliver findings for the above complaint allegation. LPA met with Caregiver Sandra Ascencio and explained the reason for the visit.

For allegation, Client was unlawfully evicted:

During interviews with staff, LPA was informed that the facility issued Client C1 an eviction notice on 4/19/2021 due to behavioral issues. The facility never followed through with the eviction and C1 continued to live at the facility until 6/3/2021. On 6/2/2021, C1 went to the doctor’s and informed the doctor that they did not want to return to the facility. The facility denied ever stating that C1 could not return to the facility. C1 was accepted and returned to the facility on 6/3/2021. After being returned to the facility, C1 signed a statement that they requested to be discharged from the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 18-AS-20210602131848
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WHITE HOME, THE
FACILITY NUMBER: 336412337
VISIT DATE: 06/13/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA attempted to contact C1 via telephone for an interview. LPA left voicemails for C1, but never received a return call.

During document review, LPA discovered that there was an eviction notice issued to C1 on 4/19/2021. The facility did not follow through with the eviction notice and C1 continued to live at the facility until 6/3/2021. LPA reviewed a document dated 6/3/2021, the document was signed and dated by C1. This document stated that C1 had requested to be discharged from the facility as of 6/3/2021. LPA reviewed an email from C1’s Inland Regional Coordinator that stated C1 was making their own choice to leave the facility and that Inland Regional could not force C1 to continue their placement at the facility. LPA reviewed a Special Incident Report (SIR) sent to state licensing dated 6/2/2021, that stated that C1 left the facility to go to a doctor’s appointment and returned to the facility on 6/3/2021.

Based on the evidence found during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Caregiver Sandra Ascencio, along with a copy of the appeal rights.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2