336424626-5-4-2026-18-AS-RORN-DTZVEJ-20260512162225

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336424626
Report Date: 05/04/2026
Date Signed: 05/04/2026 04:26:45 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
10/10/2023 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20231010135045

FACILITY NAME:	PLEASANT GROVE RESIDENTIAL		FACILITY NUMBER:	336424626
ADMINISTRATOR:	KEITH WALKER		FACILITY TYPE:	735
ADDRESS:	25183 TODD DRIVE		TELEPHONE:	(951) 924-2300
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY:	4	CENSUS: 3	DATE:	05/04/2026
		UNANNOUNCED	TIME BEGAN:	02:02 PM
MET WITH:	La Donna Robertson		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff physically assaulted client

INVESTIGATION FINDINGS:

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On May 4, 2026, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by La Donna Robertson and the purpose of the visit was explained.

Investigation consisted of the following:
On October 17, 2023, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above and it was determined that the complaint required further investigation. During that visit, C1 and 2 staff were interviewed.

On May 4, 2026, the department toured facility, interviewed Administrator (A1), 2 staff (S1-S2), 2 clients (C2-C3), and Placement Agency staff (W1) via telephone. C1 no longer lives at the facility. The department requested the following documents: Staff Roster (dated 5/4/26), Client Roster (dated: 5/4/26), C1’s Individual Program Plan (dated: ), staff training on client rights (various dates), and CPI training certification (various dates)
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

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-20231010135045

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: PLEASANT GROVE RESIDENTIAL	FACILITY NUMBER: 336424626
	VISIT DATE: 05/04/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff physically assaulted client

The detail of complaint alleges on 10/10/23 at approximately 4:30am, facility staff punched C1 on his left cheekbone.

On May 4, 2026, the department interviewed Administrator (A1) who denied allegation stating that there have been no reports of staff hitting a client. A1 stated that all staff are trained in clients rights and have CPI certification.

On May 4, 2026, between 2:30pm and 3:30pm the department interviewed the two available staff at facility (S1-S2). Of those interviewed, 2 out of 2 staff denied the allegation stating that there were no reports of staff hitting a client. 2 out of 2 staff stated that they have never hit a client nor have they witnessed any other staff hitting a client.

On May 4, 2026, the department interviewed 2 clients (C2-C3). Of those interviewed 2 out of 2 state that they like living at the facility and that they are cared for by staff. 2 out of 2 clients interviewed stated that staff have never hit them nor have they witnessed staff hitting another client.

On May 4, 2026, the department interviewed the Placement Agency staff (W1) via telephone. W1 could not recall an incident with C1 in 2023. W1 went on to state that he has no issues with the facility, that it is a well-run facility and staff treats the clients well. Lastly, he informed the department that C1 no longer lives at the facility as of February 2026 as he relocated with family out of state.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20231010135045

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: PLEASANT GROVE RESIDENTIAL	FACILITY NUMBER: 336424626
	VISIT DATE: 05/04/2026

NARRATIVE

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On May 4, 2026, the department observed the facility to be clean, safe and sanitary. The clients present were well groomed. The department also observed that staff were attentive to the clients’ needs.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

Exit interview conducted with La Donna Robertson, Lead staff

There were no deficiencies cited during today’s visit. Copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

LIC9099 (FAS) - (06/04)

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