361880704-1-19-2022-18-AS-KCLS-CBXSGA-20220224125138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880704
Report Date: 01/19/2022
Date Signed: 01/19/2022 01:10:01 PM

Unsubstantiated

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2022 and conducted by Evaluator Rohit Lama

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220111141612

FACILITY NAME:	SULE'S LOVING HOME		FACILITY NUMBER:	361880704
ADMINISTRATOR:	PARRA, SULEMA E		FACILITY TYPE:	735
ADDRESS:	7640 TOKAY AVE		TELEPHONE:	(909) 329-9740
CITY:	FONTANA	STATE: CA	ZIP CODE:	92336
CAPACITY:	4	CENSUS: 2	DATE:	01/19/2022
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator Sulema Parra		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff is violating resident's personal rights

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Melody Brown and Rohit Lama made an unannounced visit to the facility to commence a complaint investigation into the allegation mentioned above. LPAs Brown and Lama were greeted and granted entrance by Administrator Sulema Parra. LPAs identified themselves and discussed the purpose of the visit and the elements of the allegation with Sulema Parra.

The investigation consisted of interviews with relevant parties. The allegation indicates that the facility is violating Resident 1 (R1)'s personal rights. During the investigation, the LPAs did not find evidence to corroborate the allegation. Interviews were conducted with S1, S2, R1, and R2. 2/2 staff were interviewd and both indicated that the Administrator had not threatened R1. 2/2 resdients were interviewed and one resdient (R2) indicated that the Administrator had not threatened R1. An interview with R1 revealed that that the Administrator had made such a threat to R1. Furthermore, interview with both residents revealed that they are happy, comfortable, and feel safe at this facility. No other witnesses were reported.
***Continued on LIC 9099-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

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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Control Number 18-AS-20220111141612

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
RIVERSIDE, CA 92507

FACILITY NAME: SULE'S LOVING HOME	FACILITY NUMBER: 361880704
	VISIT DATE: 01/19/2022

NARRATIVE

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***Continuation from LIC 9099***
Based on the evidence, the allegation that: Staff is violating resident's personal rights is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that 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. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to the administrator.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2022

LIC9099 (FAS) - (06/04)

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