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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800122
Report Date: 04/16/2025
Date Signed: 04/16/2025 11:11:40 AM

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
04/10/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250410141853
FACILITY NAME:COLE VOCATIONAL SERVICES CUCAMONGAFACILITY NUMBER:
361800122
ADMINISTRATOR:CAMPOS, CHRISTINEFACILITY TYPE:
775
ADDRESS:1810 E ELMA CTTELEPHONE:
(909) 390-3204
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY:75CENSUS: 63DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Christine Campos/Program DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Staff is not properly safeguarding medication.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Beena Singh conducted an unannounced visit to the facility to investigate the above listed allegation and deliver findings on a complaint alleging Staff is not properly safeguarding medication. LPA Singh met with Program Director Christine Campos, facility representative, and was granted entry into the facility. The investigation conducted by LPA Singh consisted of interviews and records review.


Interviews with Program Director,staff #1, client#1 and family revealed that staff 1 left medication prescibed -medication label listed name of the Staff, as the person the crème was prescribed to in client1s bag at the day-program. Family of client#1, also indicated that Staff1 informed client#1 via phone stating that she accidentally placed her medication crème inside client#1s backpack.


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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 3
Control Number 56-AS-20250410141853
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: COLE VOCATIONAL SERVICES CUCAMONGA
FACILITY NUMBER: 361800122
VISIT DATE: 04/16/2025
NARRATIVE
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Based on LPA observations, interviews which were conducted and records review, the preponderance of evidence standard has been met. Therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division & Chapter number) are being cited on the attached LIC 9099D).

An exit interview was conducted where reports (LIC9099, LIC9099-C & LIC9099-D) were discussed and provided with appeal rights to Facility Program Director Christine Campos at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250410141853
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: COLE VOCATIONAL SERVICES CUCAMONGA
FACILITY NUMBER: 361800122
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/16/2025
Section Cited
CCR
82075
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Medication shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication
This requirement is not met as evidenced by:
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Facility staff-program Director will conduct in-service training for medication procedure and care and supervision, in regards to medication, which would include contol, handling and storage. Once completed, proof of training along with staff in attendance is to be submitted to CCL by POC due date.
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Based on interviews with staff and client, the staff did not comply with the section cited above evidenced by facility staff left medication prescibed to her in client backpack, which posed a potential 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: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3