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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880931
Report Date: 08/20/2024
Date Signed: 08/20/2024 09:21:39 AM

Substantiated


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
06/03/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240603132900
FACILITY NAME:GEMMA'S CARE CENTERFACILITY NUMBER:
361880931
ADMINISTRATOR:NASAL, MICHAELFACILITY TYPE:
735
ADDRESS:2950 ROAN STREETTELEPHONE:
(909) 218-7025
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:6CENSUS: 6DATE:
08/20/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Anamaria ConroyTIME COMPLETED:
09:30 AM
ALLEGATION(S):
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9
Staff working do not have a criminal clearance transfer association to the facility.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Anamaria Conroy and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review.

For the allegation, Staff working do not have a criminal clearance transfer association to the facility.

During staff interviews 3 out of the 4 staff, informed LPA that S1 family memeber works at the facility without a criminal record clearance. S1 admitted to LPA that their family member does not have a criminal record clearance. S1 stated their family member works at the facility.

During client interviews 3 out of the 6 clients, informed LPA that S1 family will assist them in the morning before Day Program.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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
Control Number 56-AS-20240603132900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: GEMMA'S CARE CENTER
FACILITY NUMBER: 361880931
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/21/2024
Section Cited
CCR
80065(i)(1)
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80065(i)(1) Personnel Requirements
(i) Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall:(1) Obtain a California clearance .. as required by law or Department regulations or
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Licensee has agreed to will provided training to all staff on the regulation cited above and will send a formal letter that S1 family member will not be working at the facility without a criminal record clearance.
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Based on observation and interview the licensee did not comply with the section cited above evidenced by having family members working without a criminal record clearance poses an immediate Health, Safety or personal rights risk to persons in care.
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POC due date 8/21/2024
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240603132900
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: GEMMA'S CARE CENTER
FACILITY NUMBER: 361880931
VISIT DATE: 08/20/2024
NARRATIVE
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During record review, LPA verified S1 family member does not have a Criminal Record Clearance.

Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Anamaria Conroy along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3