361880870-5-4-2026-56-AS-KCLS-DUWMX5-20260610095918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880870
Report Date: 05/04/2026
Date Signed: 05/04/2026 02:09:21 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/29/2026 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260429160559

FACILITY NAME:	JACKSON HOME		FACILITY NUMBER:	361880870
ADMINISTRATOR:	CORONADO, VALERIE		FACILITY TYPE:	735
ADDRESS:	4873 JACKSON COURT		TELEPHONE:	(909) 590-2038
CITY:	CHINO	STATE: CA	ZIP CODE:	91710
CAPACITY:	4	CENSUS: 3	DATE:	05/04/2026
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Valerie Coronado, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with Administrator Coronado and explained the elements of the complaint. LPA interviewed resident #1 (R1) in question, who could not corroborate the allegation made in this complaint. R2 was present at time of investigation. R2 could not verbalize any events that occurred at the facility. LPA interviewed Administrator Coronado (S1), who conducted in internal investigation and could not conclude that a resident was hit by staff at the facility. LPA interviewed S2, who was present at the facility at time of investigation. S2 could not corroborate the allegation that staff hit resident while in care. LPA interviewed S3, in question, who denies hitting residents in the home.

Based on the information obtained there is not enough evidence that staff hit resident while in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Coronado and a copy was left with the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2026

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 1