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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336424626
Report Date: 01/28/2025
Date Signed: 01/28/2025 12:38:05 PM

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
02/03/2021 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210203082650
FACILITY NAME:PLEASANT GROVE RESIDENTIALFACILITY NUMBER:
336424626
ADMINISTRATOR:KEITH WALKERFACILITY TYPE:
735
ADDRESS:25183 TODD DRIVETELEPHONE:
(951) 924-2300
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:4CENSUS: 4DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Desean Walker, Facility ManagerTIME COMPLETED:
12:55 PM
ALLEGATION(S):
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Staff caused injury to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived at the facility to conclude a complaint investigation concerning the above allegation. LPA Prieto met with Facility Manager Desean Walker.

Regarding the allegation that staff caused injury to a resident, LPA Prieto interviewed Resident #1 (R1), who stated that their own aggressive behavior towards Staff #1 (S1) resulted in a mark on their face. R1 took responsibility for their actions and confirmed that the mark was due to their own behavior, not S1's actions.

LPA Prieto also interviewed S1, who confirmed that R1 displayed aggressive behavior resulting in a physical altercation, leaving a mark on R1's face. S1 mentioned that R1 apologized and could not explain their actions. R1 had resided at the facility for nearly three years without any further incidents involving S1 and stated that they enjoyed their stay and felt safe since.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 01/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2025
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-20210203082650
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: PLEASANT GROVE RESIDENTIAL
FACILITY NUMBER: 336424626
VISIT DATE: 01/28/2025
NARRATIVE
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Interviews with Resident #2 (R2) and Resident #3 (R3) revealed that neither had any physical confrontations with staff or other residents. Facility Manager Walker confirmed awareness of the incident, which was documented and reported to Licensing. Walker added that R1 admitted to instigating the aggressive behavior and took responsibility for their actions. Walker noted that R1 and S1 have coexisted harmoniously for nearly three years since the incident.

Based on the information obtained, there is insufficient evidence to conclude that staff caused injury to the resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and Facility Manager Walker, and a copy was left with the facility.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2