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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360909246
Report Date: 08/04/2025
Date Signed: 08/04/2025 01:59:09 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
07/29/2025 and conducted by Evaluator Magda Malcore
COMPLAINT CONTROL NUMBER: 56-AS-20250729110801
FACILITY NAME:PADUA VILLAGE, INC.FACILITY NUMBER:
360909246
ADMINISTRATOR:SHAWN F. BARRACKSFACILITY TYPE:
735
ADDRESS:11981 MIDWAY RD.TELEPHONE:
(760) 248-6245
CITY:LUCERNE VALLEYSTATE: CAZIP CODE:
92356
CAPACITY:26CENSUS: 22DATE:
08/04/2025
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Dorris GaskinTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Facility staff are using clients prescribed medications for personal use
Licensee does not ensure staff is in good health and capable of performing assigned duties and tasks.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Magda Malcore and Eldin Serrano conducted an unannounced complaint visit to the facility. LPAs met with Program Manager, Dorris Gaskin, and informed the purpose of the visit.

Regarding the allegation, facility staff are using clients prescribed medications for personal use, it was alleged that staff #1 (S1) is using clients prescribed medications for personal use. Interviews with S1 and five (5) other staff deny using client medications for personal use. Interviews with five (5) clients deny that staff are using their prescribed medications for personal use. Review of four (4) client medication records reveals that their medications are being administered on time and as prescribed.

Regarding the allegation, Licensee does not ensure staff is in good health and capable of performing the assigned duties and tasks, it was alleged that S1 is under the influence of drugs and unable to perform their assigned duties and tasks.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
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 56-AS-20250729110801
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: 08/04/2025
NARRATIVE
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Interviews with S1 and five (5) other staff deny that staff are under the influence of drugs and incapable of performing their job duties. Interviews with five (5) clients deny that staff are under the influence of drugs and incapable of performing their job duties.

Based on record review, interviews with staff and residents, the allegations mentioned in this report are Unsubstantiated. An Unsubstantiated finding means 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 with where this report was discussed. A copy of this report was provided with appeal rights to Program Manager Gaskin at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2