361880525-9-14-2023-56-AS-EMAN-CWHVLB-20231011163139

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880525
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:34:29 AM

Unfounded

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
09/13/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230913160315

FACILITY NAME:	MERRILL GARDENS AT RANCHO CUCAMONGA		FACILITY NUMBER:	361880525
ADMINISTRATOR:	TAMO, DAVID		FACILITY TYPE:	740
ADDRESS:	9942 HIGHLAND AVENUE		TELEPHONE:	(909) 303-9545
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91737
CAPACITY:	150	CENSUS: 106	DATE:	09/14/2023
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	Administrator Usman Chaudary		TIME COMPLETED:	10:36 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is operating without a qualified administrator.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings for the above allegation. LPA met with Administrator Usman Chaudary and explained the reason for the visit.

For the allegation, Facility is operating without a qualified administrator.

During today’s visit, LPA interviewed Administrator, conducted a record review and obtain copies.
During interview with Administrator, Administrator confirm they have been the Administrator since June 26th 2023. During record review LPA verified facility is operating with a qualified Administrator.
Based on the information found during the investigation, the allegation listed above is deemed UNFOUNDED. A finding that the complaint is UNFOUNDED means that the allegation was without a reasonable basis. Therefore, the above allegation is dismissed.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 09/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023

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 3