361800216-5-10-2023-56-AS-EMAN-CS4NEZ-20230523102446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800216
Report Date: 05/10/2023
Date Signed: 05/10/2023 10:22:13 AM

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
02/16/2023 and conducted by Evaluator Victoria Chitgian

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230216161533

FACILITY NAME:	HILEA HOME		FACILITY NUMBER:	361800216
ADMINISTRATOR:	MORENO, DARLENE		FACILITY TYPE:	735
ADDRESS:	14032 OLEMA RD		TELEPHONE:	(760) 503-0124
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	4	CENSUS: 4	DATE:	05/10/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Jasmine Zetino- Direct Support Staff		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Staff not providing assistance to residents.
Staff use profanity when speaking to residents.
Staff are making resident sleep on the floor.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Victoria Chitgian conducted an unannounced visit to the facility to deliver findings for the above allegations. LPA met with Direct Support Staff (DSP) Jasmine Zetino. and explained the purpose of the visit. Investigation consisted of interviews with pertinent parties and records review.

The first allegation indicates facility staff are not providing assistance to residents. Interviews with Staff #1 (S1) and Staff #2 (S2) stated that staff do assist all clients and encourage independence. LPA interviewed client #1(C1) and discovered that staff does provide assistance. Review of Client #2 file reveal displaying behavior of falsifying allegation and lies.

The second allegation indicates facility staff use profanity. Interviews with S1 and S2 stated that they do not use profanity and keep the language professional. Interviews with C1 and C3 reveal not hearing foul language from staff. S4,S5 stated the facility is a professional setting and has not used or witnessed profanity.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230216161533

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: HILEA HOME	FACILITY NUMBER: 361800216
	VISIT DATE: 05/10/2023

NARRATIVE

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The third allegation indicates Staff are making client sleep on the floor. Interviews with S1 and S2 reveal that at no time is a client made to sleep on the floor. S1 and S2 state that a client may lay to the ground but has never been told to sleep on the floor. C1, C3 stated to have never been made to sleep on the floor, nor witnessed any other client sleep on the floor.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations 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, and a copy of this report was discussed and provided to DSP Victoria Chitgian.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Victoria Chitgian
LICENSING EVALUATOR SIGNATURE:	DATE: 05/10/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2023

LIC9099 (FAS) - (06/04)

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