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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880989
Report Date: 05/01/2025
Date Signed: 05/01/2025 10:33:27 AM

Unsubstantiated


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
07/12/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240712134126
FACILITY NAME:PEOPLE'S CARE SYCAMOREFACILITY NUMBER:
361880989
ADMINISTRATOR:ZIA PICKENSFACILITY TYPE:
737
ADDRESS:17358 SYCAMORE LANETELEPHONE:
(760) 961-1014
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:4CENSUS: 3DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Rigoberto YellTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff physically restraining a client in care
Staff not providing food to a client in care
Staff not meeting client's medical needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to the facility to conclude the investigation on the above allegations. LPA was granted entry and met with Assisting Administrator, Rigoberto Yell, and discussed the purpose for the visit. The investigation consisted of LPA observations and interviews with pertinenant parties. Client #1 (C1) no longer resides at the facility and was not available for an interview.

Regarding the allegation, staff physically restraining a client in care, it was alleged that staff were using unnecessary CPI restraints on a client in care. Interviews with two (2) clients reveals staff have not used unnecessary CPI restraints on them. Interviews with the Administrator, Davonna Mason, and four (4) staff reveals they have not used unnecessary restraints on clients in care.

Regarding the allegation, staff not providing food to a client in care, interviews with two (2) clients reveals they are provided breakfast, lunch, dinner, snacks and have enough food to eat.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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-20240712134126
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: PEOPLE'S CARE SYCAMORE
FACILITY NUMBER: 361880989
VISIT DATE: 05/01/2025
NARRATIVE
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Interviews with the Administrator, and four (4) staff reveals they have not refused to provide food to clients in care.

Regarding the allegation, staff not meeting client's medical needs, interviews with two (2) clients, the Administrator, four (4) staff, and outside parties reveals insufficient evidence to corroborate this allegation.

Based on information obtained during this investigation, the allegations mentioned in this report are Unsubstantiated. 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 with appeal rights to Assisting Administrator Yell at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2