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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880686
Report Date: 03/27/2024
Date Signed: 03/27/2024 09:48:26 AM

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
03/19/2024 and conducted by Evaluator Anna Fannell
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240319154705
FACILITY NAME:HELPING HEARTS BLACKWOODFACILITY NUMBER:
361880686
ADMINISTRATOR:CESAR ARGUETAFACILITY TYPE:
772
ADDRESS:11253 BLACKWOOD STTELEPHONE:
(909) 677-6644
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:6CENSUS: 6DATE:
03/27/2024
UNANNOUNCEDTIME BEGAN:
08:48 AM
MET WITH:Priscilla Gomez - BHTTIME COMPLETED:
09:50 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulting in resident being assaulted by another resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Fannell conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegations. LPA met with behavioral health technicians (BHT) who were advised of the purpose of visit. Staff phoned supervising program coordinator, Brian Whitworth, who was informed of the purpose of today's visit. The investigation consisted of facility inspection and resident and staff interviews. LPA was unable to interview R2 due to not being present at the facility during today's visit.

It is alleged that Lack of supervision resulting in Resident (R1) being assaulted by another Resident (R2). LPA observed two staff during the visit. Interview with staff reveal that there are at least two staff in the morning shift and at least one staff in the evening shift. Interviews with residents reveal that night staff check on residents. Interview with R1 revealed that they get along with their current roommate and denied being assaulted by R2. This allegation is therefore unsubstantiated.

A finding of UNSUBSTANTIATED means, although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted with and a copy of this report was provided to BHT Priscilla Gomez.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Fannell
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024
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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