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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800061
Report Date: 05/24/2023
Date Signed: 05/24/2023 10:13:25 AM

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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2023 and conducted by Evaluator Melody Brown
COMPLAINT CONTROL NUMBER: 56-AS-20230510153551
FACILITY NAME:HELPING HEARTS EUCLIDFACILITY NUMBER:
361800061
ADMINISTRATOR:SMITH, MELLISAFACILITY TYPE:
772
ADDRESS:747 NORTH EUCLID AVETELEPHONE:
(909) 983-6123
CITY:ONTARIOSTATE: CAZIP CODE:
91762
CAPACITY:10CENSUS: 10DATE:
05/24/2023
ANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Program Director Valerie Daniels TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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On 05/24/2023 at 10:00 AM, Licensing Program Analysts (LPAs) Melody Brown and Mary Rico met with Program Director Valerie Daniels at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegation. LPAs Brown and Rico explained the purpose of the Office Visit. The investigation consisted of file review, interviews with staff and relevant parties as well as observation.

The investigation was conducted by LPA Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Illegal Eviction. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with facility staffs and San Bernardino Mental Health Clinic Supervisor at Department of Behavioral Health indicated that Client #1 (C1) bed was authorized to be closed at the facility last 05/01/2023 as the facility is unable to accommodate C1 on injectable insulin due to the facility not having nursing oversight at the facility.
***Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
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-20230510153551
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
, CA 92507
FACILITY NAME: HELPING HEARTS EUCLID
FACILITY NUMBER: 361800061
VISIT DATE: 05/24/2023
NARRATIVE
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 LPA Brown’s investigations revealed that the hospital informed the facility of C1’s medication changed from insulin injection to medication by mouth last 05/02/2023 at 11:55 AM, not the same day of the medication changed last 05/01/2023. but the next day, wherein the bed at the facility was already authorized by San Bernardino Department of Behavior Health to be closed.

Based on interviews and records review, the allegation Illegal Eviction is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, where this report (LIC9099), was discussed and provided to Program Director Valerie Daniels.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2