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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800165
Report Date: 10/13/2022
Date Signed: 10/13/2022 01:22:43 PM

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
10/06/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221006130739
FACILITY NAME:AUSTIN SMALL ARIZONA FAMILY HOME IIFACILITY NUMBER:
361800165
ADMINISTRATOR:AUSTIN, ALEXANDRIAFACILITY TYPE:
735
ADDRESS:17049 LA VESU ROADTELEPHONE:
(909) 823-2624
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:6CENSUS: 3DATE:
10/13/2022
UNANNOUNCEDTIME BEGAN:
11:16 AM
MET WITH:Alexandria AustinTIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Resident in care is not being supervised.
A/C unit not working.
Facility does not have adequate food supply.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Anna Bueno and Amber Coleman conducted an unannounced visit to the facility to investigate the above mentioned complaint allegation and deliver findings. LPA identified herself to Licensee Alexandria Austin and staff Justin Poole who were notified of the reason for today’s visit and the elements of the allegation. Licensee Adeline Austin was phoned by Alexandria and Adeline arrived shortly. The investigation included staff interviews, facility observations, and records review.

Allegation 1: Resident in care is not being supervised. LPAs observed that the facility had two staff during today's visit. Interviews with staff revealed that the facility had a live-in staff through 9/28/2022 and, since 9/29/22 through current, three staff have a rotating schedule for afternoon and evening supervision. Records reviewed showed that no consumer requires one on one supervision. For these reasons, the allegation is unsubstantiated.
Allegation 2: A/C unit not working. LPAs, Licensee Alexandria, and staff Poole observed that the air-conditioner is working. Staff interviews revealed that the facility A/C was broken in September for 6 days until
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
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-20221006130739
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: AUSTIN SMALL ARIZONA FAMILY HOME II
FACILITY NUMBER: 361800165
VISIT DATE: 10/13/2022
NARRATIVE
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the A/C was replaced on 9/21/22 and the clients were temporarily relocated to another licensed home of the Licensee. This allegation is therefore unsubstantiated.
Allegation 3: Facility does not have adequate food supply. LPAs and Licensee Alexandria observed the facility refrigerators and pantry stocked with food items. Staff interviews revealed that there is a monthly budget for food however all other items such as paper and cleaning supplies, water, hygiene and grooming items were provided separately by the Licensee. This allegation is therefore unsubstantiated.

A finding of UNSUBSTANTIATED means that although the allegations may have happened or are 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 was discussed with, and a copy was provided to Licensees at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2