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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881103
Report Date: 11/03/2022
Date Signed: 11/03/2022 01:06:34 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
10/28/2022 and conducted by Evaluator Anna Bueno
COMPLAINT CONTROL NUMBER: 56-AS-20221028111812
FACILITY NAME:ZION ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
361881103
ADMINISTRATOR:WATKINS, UNIQUEFACILITY TYPE:
735
ADDRESS:11025 MESA LINDA ST.TELEPHONE:
(909) 749-0974
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:5CENSUS: 4DATE:
11/03/2022
UNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Unique WatkinsTIME COMPLETED:
01:08 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff speak inappropriately to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Anna Bueno and Amber Coleman conducted an unannounced visit to the facility to investigate the above mentioned complaint allegation and deliver findings. LPAs identified themselves to administrator Unique Watkins who was notified of the reason for today’s visit and the elements of the allegation. The investigation included resident and staff interviews and records review.

It is alleged that staff speak inappropriately to resident. LPAs interviewed three clients and three staff who all spoke English. Based on information discovered during interviews, LPAs were unable to find corroborating evidence that staff speak inappropriately to clients.

A finding of UNSUBSTANTIATED means 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 with Ms. Watkins and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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