361881151-12-14-2023-56-AS-KCLS-D2VL72-20240228072936

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881151
Report Date: 12/14/2023
Date Signed: 12/14/2023 03:27:13 PM

Unfounded

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
12/08/2023 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231208122525

FACILITY NAME:	HACIENDA LIVING		FACILITY NUMBER:	361881151
ADMINISTRATOR:	VELAZQUEZ, RAUL		FACILITY TYPE:	740
ADDRESS:	11412 TELEPHONE AVE		TELEPHONE:	(213) 440-4823
CITY:	CHINO	STATE: CA	ZIP CODE:	91710
CAPACITY:	6	CENSUS: 5	DATE:	12/14/2023
		UNANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Mirian Velasquez, lead staff		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not allowing resident to have visitors

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regrading the above allegation. LPA met with lead staff Mirian Velasquez to discuss the elements of the complaint.
Regarding allegation that staff are not allowing resident to have visitors; interviews with staff #1 (S1), S2 and S3 and administrator reveal the resident #1 (R1), in question, does have their visitor on a daily basis for approximately 2 hours in the morning and 2 hours in the evening. Staff state that visitor has never been denied entry into the facility.
This agency has investigated the complaint alleging staff are not allowing resident to have visitors. We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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