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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880977
Report Date: 11/18/2025
Date Signed: 11/18/2025 01:31:07 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
07/14/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20250714092142
FACILITY NAME:LEMON GRASS RESIDENTIAL CAREFACILITY NUMBER:
361880977
ADMINISTRATOR:HAIRE, JANECIAFACILITY TYPE:
735
ADDRESS:10832 LEMON GRASS AVE.TELEPHONE:
(909) 600-9790
CITY:FONTANASTATE: CAZIP CODE:
92337
CAPACITY:4CENSUS: 0DATE:
11/18/2025
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Janecia Haire, AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility staff are not ensuring that an appropriately skilled professional is assisting the client with injections
Facility staff are not meeting clients dietary needs
Facility staff are not seeking timely medical attention for client in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Janecia Haire, Administrator and discussed the purpose of the visit. The investigation consisted of LPA observations, pertinent record reviews and interviews with staff and client.

The allegation that Facility staff are not ensuring that an appropriately skilled professional is assisting the client with injections. LPA interviewed four (4) staff they denied administering insulin to the client. The four (4) staff interviewed stated that Client #1 (C1) administered their own insulin. Client #1 (C1) no longer resides at the facility as of 07/13/2025 based on the interview of Staff #1 (S1). Based on LPA observations and record reviews, C1 does not reside at the facility anymore.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
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-20250714092142
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: LEMON GRASS RESIDENTIAL CARE
FACILITY NUMBER: 361880977
VISIT DATE: 11/18/2025
NARRATIVE
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The allegation that Facility staff are not meeting clients dietary needs. LPA interviewed four (4) staff, they stated that C1 does not have a special diet. LPA observed the menu and there is a carb count to assist C1 with their diabetes to regulate their blood sugar levels.

The allegation that Facility staff are not seeking timely medical attention for client in care. LPA interviewed four (4) staff and they stated that they do seek medical attention for clients in care in a timely manner. The four (4) staff have not refused to seek medical attention for clients.

Based on evidence obtained during this investigation, the allegation above is Unsubstantiated; meaning 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.

An exit interview was conducted where this report was discussed, and a copy of this report was provided to Janecia Haire, Administrator at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2