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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880989
Report Date: 10/16/2025
Date Signed: 10/16/2025 11:17:00 AM

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-20250714085842
FACILITY NAME:PEOPLE'S CARE SYCAMOREFACILITY NUMBER:
361880989
ADMINISTRATOR:DAVONNA MASONFACILITY TYPE:
737
ADDRESS:17358 SYCAMORE LANETELEPHONE:
(760) 961-1014
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:4CENSUS: 4DATE:
10/16/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ernest Montes, Registered Behavior Technician (RBT)TIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff are handling client in care in a rough manner
Staff caused injuries to client in care
Licensee does not ensure that staff are adequately trained
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 Ernest Montes, Registered Behavior Technician (RBT), and discussed the purpose of the visit. The investigation consisted of LPA observations, pertinent record reviews and interviews with staff and clients.

The allegation that staff are handling client in care in a rough manner. Six (6) staff interviewed denied handling clients in a rough manner. LPA interviewed four (4) clients. Interview with Client #2 (C2) revealed that staff have not handled them in a rough manner. Interviews with Client #1 (C1), Client #3 (C3), and Client #4 (C4) were made; however, they were unable to provide information.



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

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
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-20250714085842
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: PEOPLE'S CARE SYCAMORE
FACILITY NUMBER: 361880989
VISIT DATE: 10/16/2025
NARRATIVE
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The allegation that staff caused injuries to client in care. Six (6) staff interviewed denied causing injuries to clients in care. LPA interviewed four (4) clients. Interview with Client #2 (C2) revealed that staff have not caused injuries to client in care. Interviews with Client #1 (C1), Client #3 (C3), and Client #4 (C4) were made; however, they were unable to provide information.

The allegation that Licensee does not ensure that staff are adequately trained. Based on LPA observations, interviews, and record reviews, the facility staff is properly trained. Interviews conducted with facility staff, all staff have received required trainings and certifications to provide proper care for clients. LPA conducted staff file reviews and observed that training was completed. LPA observed certificates of completion to be on file with staff.

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 Ernest Montes (RBT) at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2