361800232-5-12-2025-56-AS-KCLS-DJ5T4W-20250630142437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800232
Report Date: 05/12/2025
Date Signed: 05/12/2025 03:05:34 PM

Unsubstantiated

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
01/22/2025 and conducted by Evaluator Eldin Serrano

COMPLAINT CONTROL NUMBER: 56-AS-20250122145314

FACILITY NAME:	SKY BLUE SUMMER CARE		FACILITY NUMBER:	361800232
ADMINISTRATOR:	WALKER, CLAUDIA		FACILITY TYPE:	735
ADDRESS:	16410 NISQUALLI RD		TELEPHONE:	(760) 596-1659
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	4	CENSUS: 4	DATE:	05/12/2025
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Claudia Walker, Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff physically abuse residents
Facility staff verbally abuse residents
Facility staff do not dispense medications as prescribed
Licensee allows uncleared adult(s) to work in the facility
Facility staff are falsifying personnel records
Facility staff do not ensure facility is maintained clean
Facility staff do not ensure facility is maintained in good repair

INVESTIGATION FINDINGS:

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On 5/12/2025 at 2:00 PM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility to deliver the findings of the above allegations. LPAs met with Administrator Claudia Walker to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation.

Allegation #1: Facility staff physically abuse residents– Based on interview, 3 out of 3 clients stated that they did not witness or know of any staff physically abusing any residents.

Allegation #2: Facility staff verbally abuse residents - Based on interview, 3 out of 3 clients stated that they did not witness or know of any staff verbally abusing any residents. All three (3) clients all stated that the staff does not verbally/physically abuse anyone in the facility.

*** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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-20250122145314

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: SKY BLUE SUMMER CARE	FACILITY NUMBER: 361800232
	VISIT DATE: 05/12/2025

NARRATIVE

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Allegation #3 Facility staff do not dispense medications as prescribed - Based on LPA medication review, LPA audited client #1, #2 and #3 medications, and no issues were observed.

Allegation #4 Licensee allows uncleared adult(s) to work in the facility – Based on record review, LPA observed that all the staff in the facility have criminal record clearance.

Allegation #5 Facility staff are falsifying personnel records – Based on interview, 3 out of 3 clients stated that they did not witness or know of any staff falsifying personnel records.

Allegation #6 Facility staff do not ensure facility is maintained clean – LPA observed that the facility is maintained clean all throughout including the backyard and garage.

Allegation #7 Facility staff do not ensure facility is maintained in good repair – Based on LPA observation, the facility is well maintained and in good repair.

During the 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 and LIC9099C were discussed and provided to Administrator Claudia Walker.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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