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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880561
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:58:49 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
12/10/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241210160013
FACILITY NAME:LAS PALMAS RESIDENTIAL CAREFACILITY NUMBER:
361880561
ADMINISTRATOR:MEDINA, RYANFACILITY TYPE:
735
ADDRESS:7128 LAS PALMAS DRTELEPHONE:
(909) 330-2231
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 3DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Administrator-Ryan MedinaTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not ensuring client's personal care needs are met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 02/12/2025 at 2:00PM, Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Singh was greeted and granted entry by Facility Administrator
The investigation was conducted by LPA Singh. The investigation consisted of file review and interviews with relevant parties.

The first allegation indicates facility Staff are not ensuring client's personal care needs are met.

During the investigation, LPA Singh did not find evidence to corroborate the allegation. Client #1 was prescribed a new medication causing accidents and foul odor and weight gain. Staff interviews, record review, physician report and observation revealed Client #1 was sent to school in clean clothes, bathed twice daily, and had spare clothes in his backpack to change in the event of accidents, due to medication changes. LPA observed Client #1 in clean clothes with no odor during this visit.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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 2
Control Number 56-AS-20241210160013
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: LAS PALMAS RESIDENTIAL CARE
FACILITY NUMBER: 361880561
VISIT DATE: 02/12/2025
NARRATIVE
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Based on the evidence gathered during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted where this report, LIC9099, 9099C was discussed with Facility Licensee Ryan Medina and Administrator Margarita Medina and provided to Licensee Ryan Medina.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2