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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881267
Report Date: 07/25/2025
Date Signed: 07/31/2025 02:37:20 PM

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
06/18/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250618080836
FACILITY NAME:HANSEN RESIDENTIAL CAREFACILITY NUMBER:
361881267
ADMINISTRATOR:CLARKE, ZOIEFACILITY TYPE:
735
ADDRESS:374 S. VAN NESS AVE.TELEPHONE:
(909) 608-1699
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:4CENSUS: 3DATE:
07/25/2025
UNANNOUNCEDTIME BEGAN:
01:02 PM
MET WITH:Marcus Williams- CaregiverTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Personal rights
INVESTIGATION FINDINGS:
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 *** This is an amended report Licensee/Administrator has signed the report***

Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Caregiver Marcus Williams and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Personal Rights. Regarding the allegation “Personal Rights” LPA conducted interviews with Client #2, and Client #3, LPA went over the allegation with both clients and C#2, and C#3, informed LPA that they did not witness Staff #1 threat, push, or mistreat C#1. Client #2, and Client #3 informed LPA that both feel safe and are treated well by every staff at the facility. LPA conducted an interview with S#1 who informed LPA that C#1 was experiencing a behavior S#1 informed LPA that C#1 came close to S#1 and S#1 extended hand out and informed C#1 “Personal Space”. Staff #1 informed LPA that staff did not threat, push, or mistreated, C#1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
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-20250618080836
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: HANSEN RESIDENTIAL CARE
FACILITY NUMBER: 361881267
VISIT DATE: 07/25/2025
NARRATIVE
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During record review LPA discovered that Upland PD responded to the Hansen address and spoke to both Client #1, and Staff #1, LPA discovered that Upland PD later took Client #1 on a 5150 hold and transferred C#1 to local behavior health center. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is 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 (LIC 9099) was discussed, and a copy was provided to Facility Caregiver Marcus Williams at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2