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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361800433
Report Date: 03/23/2023
Date Signed: 03/23/2023 03:24:56 PM

Document Has Been Signed on 03/23/2023 03:24 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:WELLSPRING CENTERFACILITY NUMBER:
361800433
ADMINISTRATOR:LAWRENCE LAWLERFACILITY TYPE:
772
ADDRESS:15217 SAN BERNARDINO AVENUETELEPHONE:
(951) 643-2150
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY: 16CENSUS: 15DATE:
03/23/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:18 PM
MET WITH:Larry Lawler, Administrator TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced. This case management visit is a follow-up visit to the health and safety visit made to the facility on November 30, 2022. LPA met with Administrator, Larry Lawler and explained the purpose of the visit.

LPA Prieto conducted an initial case management visit in response to an Unusual Incident/Injury Report (UIR) received by this agency from the facility on November 28, 2022. The UIR alleged that staff #1 purchased various items (alcohol, e-cigarettes, and candy) for resident #1 (R1), S1 touched R1 inappropriately, and S1 drugged and sexually assaulted R1.

This incident was investigated by department staff. Department staff interview with the administrator revealed that they were made aware of the allegations almost two (2) weeks after R1 was discharged from the facility. The administrator stated they questioned resident #2 (R2) about the allegation. R2 was R1’s former roommate. The administrator stated that according to R2, S1 gave R1 their phone number. The administrator stated that R2 denied S1 and R1 had sexual relations; however, R2 stated that R1 and S1 had dinner. The administrator said they started an investigation into S1, and it was later decided to terminate S1. However, it was revealed through the course of this investigation that S1 resigned before the termination could be given.



Department staff attempted to locate R1 for an interview and was unsuccessful. Department staff interview with S1 revealed that initially, S1 denied knowing R1, and S1 would also state, “I plead the 5th”. Department staff file review revealed that no reports of S1 or any other facility staff member bringing items like alcohol for R1 or any other resident in care. Department staff file review also revealed that R1 stated S1 met them after R1 was discharged from the facility, drugged them, and sexually assaulted them. There is no evidence or witnesses to corroborate the allegations; therefore, investigation into this incident is closed.

No deficiencies were cited during this visit. An exit interview was conducted where this report (LIC 809) was discussed and provided to Lawler.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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