360909246-5-21-2026-56-AS-EMAN-DUMUBF-20260601152616

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360909246
Report Date: 05/21/2026
Date Signed: 05/21/2026 03:32:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/26/2026 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260126153352

FACILITY NAME:	PADUA VILLAGE, INC.		FACILITY NUMBER:	360909246
ADMINISTRATOR:	SHAWN F. BARRACKS		FACILITY TYPE:	735
ADDRESS:	11981 MIDWAY RD.		TELEPHONE:	(760) 248-6245
CITY:	LUCERNE VALLEY	STATE: CA	ZIP CODE:	92356
CAPACITY:	26	CENSUS: 17	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Stephanie Kaplan		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not prevent client from attacking another client in care
Staff do not ensure adequate care and supervision is provided to clients
Facility staff did not ensure reporting requirements were followed

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Stephanie Kaplan and explained the purpose of the visit regarding the allegations stated above.

First allegation: Staff did not prevent client from attacking another client in care. Regarding the allegation stated above, LPA conducted an interview with Staff #1 regarding the alleged allegation Staff #1 informed LPA that there have been incidents involving resident on resident physical aggression Staff #1 informed LPA that staff supervision is always provided where residents are immediately separated and redirected. Staff #1 provided LPA with incident reports involving Resident #1 being physically aggressive with Resident #2 LPA observed that reports were made and provided to the required agencies. In addition, during the review of records LPA observed that staff intervene between Resident #1 and Resident #2 and reported that no injuries were observed and first aid was not used.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

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 56-AS-20260126153352

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PADUA VILLAGE, INC.	FACILITY NUMBER: 360909246
	VISIT DATE: 05/21/2026

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 conducted interviews with Staff #2, Staff #3, and Staff #4, regarding the alleged allegation and Staff #2-4 informed LPA that resident on resident physical aggression may occur however, there is enough staff and supervision where staff immediately intervene and assess the situation. LPA conducted interviews with Resident #3, Resident #4, and Resident #5, regarding the alleged allegation and Resident #3-5 informed LPA that physical aggression does not occur often however, when it does residents informed LPA that staff intervene. Resident #3-5 informed LPA that they feel safe and stated that there is enough staff support and supervision.

Second allegation: Staff do not ensure adequate care and supervision is provided to clients: Regarding the allegation stated above, LPA conducted interviews with Staff #2, Staff #3, and Staff #4, regarding the alleged allegation and Staff #2-4 informed LPA that resident on resident physical aggression may occur however, there is enough staff and supervision where staff immediately intervene and assess such situations. LPA conducted interviews with Resident #3, Resident #4, and Resident #5, regarding the alleged allegation and Resident #3-5 informed LPA that physical aggression does not occur often however, when it does residents staff intervene. Resident #3-5 reported to LPA that they feel safe and stated that there is enough staff support and supervision.

Third allegation: Facility staff did not ensure reporting requirements were followed. Regarding the allegation stated above, LPA conducted an interview with Staff #1 regarding the alleged allegation Staff #1 informed LPA that any incident that involves a resident gets reported to the required agency. LPA collected Special Incident reports pertaining to Resident #1involving physical aggression towards residents. During the review of records LPA discovered that reports pertaining to Resident #1 were documented and provided to the required agency. Based on corroborating evidence LPA has determined that the above allegation is Unsubstantiated, meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Stephanie Kaplan.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2