<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800429
Report Date: 06/24/2022
Date Signed: 06/24/2022 02:13:58 PM

Substantiated


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
06/23/2022 and conducted by Evaluator Rohit Lama
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220623120124
FACILITY NAME:HELPING HEARTS BONANZAFACILITY NUMBER:
361800429
ADMINISTRATOR:MANUEL SOTOFACILITY TYPE:
772
ADDRESS:14516 BONANZA ROADTELEPHONE:
(909) 771-9940
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:10CENSUS: 10DATE:
06/24/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Frank Pesqueira, Program DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is not allowed to leave facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:45 PM on 06/24/2022, Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegation listed above. LPA met with Frank Pesqueira,Program Director.

The allegation above states that the Clients of the facility are not allowed to leave the facility for social outings by themselves. LPA conducted interviews with Staff #1 (S1), Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5). During the interviews, S1, R1, R3, R4, and R5 stated that the facility does not allow the Clients to leave the facility on their own. This policy of not allowing clients to leave the facility unsupervised has been in place for more than six (6) months.

CONTINUED ON LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
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 5
Control Number 56-AS-20220623120124
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 BONANZA
FACILITY NUMBER: 361800429
VISIT DATE: 06/24/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED FROM LIC 9099

Based on the evidence gathered during the investigation, the above allegation is found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is being cited on the attached LIC 9099-D.

LPA conducted an exit interview where this report was discussed with the Licensee. A copy of this report was provided to the Program Director at the conclusion of this investigation. A copy of the Appeal Rights were also provided to the Licensee.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20220623120124
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 BONANZA
FACILITY NUMBER: 361800429
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/25/2022
Section Cited
CCR
81072(a)(6)
1
2
3
4
5
6
7
81072 Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (6) To leave or depart the facility at any time. The regulation has not been met as evidenced by:
1
2
3
4
5
6
7
Program Director (PD) has agreed to conduct an In-Service Training with staff reviewing Personal RIghts Regulations for Clients. PD agreed to immediately change facility's policy reagrding leaving the facility. PD will submit proof of corrections to LPA in the form of a scanned document stating regulations
8
9
10
11
12
13
14
interviews and records review the Licensee does not allow Clients to leave the facility. This poses an immediate Health and Safety risk to Clients in care.
8
9
10
11
12
13
14
reviewed, date of training, printed names and signatures of staff trained. This will be submitted by the Plan of Correction (POC) due date. Those not working will be trained on the first day back. PD agreed to provide proof that all staff have been trainined by 06/29/2022.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/23/2022 and conducted by Evaluator Rohit Lama
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220623120124

FACILITY NAME:HELPING HEARTS BONANZAFACILITY NUMBER:
361800429
ADMINISTRATOR:MANUEL SOTOFACILITY TYPE:
772
ADDRESS:14516 BONANZA ROADTELEPHONE:
(909) 771-9940
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:10CENSUS: 10DATE:
06/24/2022
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Frank Pesqueira, Program DirectorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not treating resident with dignity and respect.
Staff is mismanaging resident's medication.
Staff is mismanaging resident's money.
Resident is not allowed vistors.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:45 PM on 06/24/2022, Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegation listed above. LPA met with Frank Pesqueira,Program Director.

LPA conducted interviews with Staff #1 (S1), Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5).

The first allegation states that Staff is not treating residents with dignity and respect. 5 out of 5 residents stated that staff members are nice and that they are happy here. 5 out of 5 residents stated that they feel staff speaks to them in a respectful manner.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20220623120124
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 BONANZA
FACILITY NUMBER: 361800429
VISIT DATE: 06/24/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
CONTINUED FROM LIC 90999-A

The second allegation states that medication is not managed properly. 5 out of 5 resdents stated that medication is always given correctly and in a timely manner. Review of MARs showed that medication administration is documented properly. No evidence of medication mismanagement was observed.

The third allegation states that the resident's money is not handled appropriately. 5 out of 5 residents stated that money is handled appropriately. All 5 residents stated that they have never had any issues when attempting to obtain monies. All 5 residents stated that there has never been any inconsistencies with the amount of money the facility was holding for the respective clients.

The fourth allegation states that visitation is not allowed. Interviews with R1, R2, R3, R4, and R5 revelaed that visitation is allowed. All 5 residents stated that they have not had any issues when attempting to meet with visitors.

Based on the evidence gathered during the investigation, the above allegation is found to be Unsubstantiated. 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.

LPA conducted an exit interview where this report was discussed with the Licensee. A copy of this report was provided to the Program Director at the conclusion of this investigation.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5