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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360910501
Report Date: 03/04/2026
Date Signed: 04/08/2026 01:20:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
03/02/2026 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20260302082010
FACILITY NAME:OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTAFACILITY NUMBER:
360910501
ADMINISTRATOR:HERNANDEZ, ANNABELLFACILITY TYPE:
775
ADDRESS:9160 MONTE VISTA AVE.TELEPHONE:
(909) 621-3884
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:66CENSUS: 52DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kenneth Baidoo, Case ManagerTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff did not call emergency services as a medical protocol
INVESTIGATION FINDINGS:
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****This is an amendment of the original visit date of 3/4/2026****
On 4/8/2026, Licensing Program Analysts (LPA) Eldin Serrano visited the facility to investigate the above-mentioned allegation and deliver findings. LPA met with Case Manager Kenneth Baidoo to discuss the purpose of the visit. The investigation consisted of interviewing relevant parties, record review, as well as observation.

The allegation indicates that staff did not call emergency services as a medical protocol - Based on interviews and a review of records, it was determined that Client #1 (C1) sustained a chipped tooth and a cut on the lip as a result of a fall. Staff did not contact emergency medical services following the incident to ensure appropriate medical assessment. C1’s parents later transported C1 to the emergency room that same evening.

Based on interviews and file review, the preponderance of evidence standard has been met, therefore, the allegation is substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 3).

An exit interview was conducted, where this report, LIC9099, LIC9099D along with appeal rights, were provided to Kenneth Baidoo.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
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 4
Control Number 56-AS-20260302082010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTA
FACILITY NUMBER: 360910501
VISIT DATE: 03/04/2026
NARRATIVE
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*****this is a blank page*****
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
03/02/2026 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20260302082010

FACILITY NAME:OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTAFACILITY NUMBER:
360910501
ADMINISTRATOR:HERNANDEZ, ANNABELLFACILITY TYPE:
775
ADDRESS:9160 MONTE VISTA AVE.TELEPHONE:
(909) 621-3884
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:66CENSUS: 52DATE:
03/04/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Kenneth Baidoo, Case Manager TIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Due to lack of supervision, client fell and sustained an injury
Staff did not notify authorized representative of incident
INVESTIGATION FINDINGS:
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*****This is an amendment of the original visit date of 3/4/2026****
On 4/8/2026 at 12:00 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with Case Manager Kenneth Baidoo to explain the purpose of the visit. The investigation consisted of record review, interviews with relevant parties as well as facility observation.
Allegation #1: Due to lack of supervision, client fell and sustained an injury – Based on interviews, it was determined that the facility operates as a 3 to 1 program rather than providing 1 to 1 supervision, which had been disclosed to the family prior to Client #1 (C1) admission to the program. LPA was unable to corroborate the allegation.
Allegation #2: Staff did not notify authorized representative of incident - Based on interviews and record review, it was confirmed that the facility staff notified the family of the incident. The allegation cannot be substantiated.
Information received during investigation; LPA did not find evidence to corroborate the allegations.
Based on the evidence, the allegations mentioned above are 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, therefore the allegation is unsubstantiated at this time.
An exit interview was conducted where this report, LIC9099 was discussed and provided to Kenneth Baidoo.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20260302082010
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: OPARC ADULT DEVELOPMENTAL CENTER-MONTE VISTA
FACILITY NUMBER: 360910501
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/05/2026
Section Cited
CCR
82075(a)
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Title 22, Division 6 Chapter 3 Article 06. Continuing Requirements 82075 (a)
Health-Related Services (a)The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services.This requirement is not met as evidence by:
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Licensee will submit a signed statement of understanding of the regulation and shall conduct an in-house training signed by all staff.
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Based on observation, interviews and record review, the licensee did not comply with the section cited above by not ensuring that the facility staff call for emergency medical services to ensure appropriate medical assessment for the client in care which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4