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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881272
Report Date: 10/08/2025
Date Signed: 10/08/2025 03:22:59 PM

Substantiated


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
07/02/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250702161225
FACILITY NAME:ST. CLARE FAMILY HOMEFACILITY NUMBER:
361881272
ADMINISTRATOR:SANCHEZ,ANTONIOFACILITY TYPE:
735
ADDRESS:2608 GARFIELD AVENUETELEPHONE:
(909) 295-9740
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:4CENSUS: 4DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Antonio SanchezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Licensee is not ensuring that staff follow resident's diet as prescribed by resident's physician.
Licensee is not providing services to resident as agreed to in the Admission Agreement.
Licensee is not ensuring lthat recreational activities are provided for resident(s) in care.
Licensee is retaining a resident with a higher level of care need.
INVESTIGATION FINDINGS:
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10
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13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Antonio Sanchez and explained the purpose of the visit. The investigation consisted of interviews, review of records, and observations.

First allegation: Licensee is not ensuring that staff follow resident's diet as prescribed by resident's physician. Regarding the allegation LPA conducted a file review pertaining to Client #1 upon review LPA discovered that a physician’s diet order was prescribed to C#1 per physician’s request. Furthermore, during observation and record review LPA discovered that a meal plan along with menu adhering C#1 diet order was not implemented. LPA conducted an interview with Staff #1 who informed LPA that a meal plan along with a menu was still being discussed between R#1 responsible party, the nutritionist, and Inland Regional Center. LPA observed that R#1 was admitted to the facility on May 1,2025 and R#1 diet order was prescribed on April 17,2025 prior to R#1 admission. In addition, LPA observed R#1 physicians report indicating that C#1 required a special food diet, which facility did not adhere according to C#1 orders.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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 6
Control Number 56-AS-20250702161225
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: ST. CLARE FAMILY HOME
FACILITY NUMBER: 361881272
VISIT DATE: 10/08/2025
NARRATIVE
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Second allegation: Licensee is not providing services to resident as agreed to in the Admission Agreement. Regarding the allegation, LPA conducted a file review pertaining to Client #1 upon record review LPA discovered that on several occasions Client #1 responsible party was providing transportation to client’s medical appointments because facility was unable to provide transportation for C#1. LPA conducted a review of C#1 admission agreement and discovered that based on client’s basic needs and services the facility will provide clients medical transportation at no cost. LPA conducted an interview with Staff #1 pertaining to the allegation and S#1 informed LPA that apart from him no one at the facility has a driver’s license to drive. LPA conducted an interview with S#2, S#3, and S#4, who informed LPA that they currently do not have a drivers license and are not able to drive.

Third allegation: Licensee is not ensuring that recreational activities are provided for resident(s) in care. Regarding the allegation LPA conducted an interview with S#1 pertaining to the alleged allegation. During the interview with S#1 LPA observed that facility did not have an activities calendar posted in common area. S#1 informed LPA that residents attend Day Program and go on outings while at Day Program. S#1 informed LPA that C#2 is on a wheelchair and facility does not have a wheelchair adaptive vehicle that can accommodate C#2 during recreational activities. S#1 informed LPA that facility provides activities to all clients at the facility.

Fourth allegation: Licensee is retaining a resident with a higher level of care need. Regarding the allegation LPA conducted a walkthrough of the facility during the walkthrough LPA observed C#2 to be on a wheelchair. LPA conducted an interview with S#1 who informed LPA that Client #2 is unable to walk and utilizes a wheelchair. S#1 further explained that IEHP conducts all non-emergency (medical appointments), transportations to C#2. In addition, S#1 informed LPA that in case of an emergency involving C#2 facility will contact fire department which will then transport C#2. LPA continued the inspection and discovered that three out of three staff are not eligible to operate a vehicle. Furthermore, LPA observed that facility does not have a wheelchair adaptive vehicle that can meet C#2 needs. Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the residents’ is valid because the preponderance of the evidence standard has been met. Title 22 regulations 87468.1 (a)(2), Personal Rights General of Residents in All Facilities from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.
An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided, along with a copy of the appeal rights to Facility Administrator Antonio Sanchez.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 56-AS-20250702161225
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: ST. CLARE FAMILY HOME
FACILITY NUMBER: 361881272
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/17/2025
Section Cited
CCR
80076(a)(6)
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Food Service...(a)... in facilities providing meals to clients, the following shall apply: (6) ...Modified diets prescribed by a client’s physician as a medical necessity shall be provided.

This requirement is not met as evidence by:
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The Licensee has agreed and will read the entire Food Service regulation will train staff in the above regulation according to cleints special diets. Licensee will provide acknowledgement of understanding signed by all staff. Acknowledgement will be sent via email to LPA by POC date 10/17/2025.
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Based on observation, interviews, and record review, the licensee did not ensure to meet food service needs for 1 out of 1 client in care, which poses a potential health, safety, or personal rights risk to clients in care
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Type B
10/17/2025
Section Cited
CCR
80075(a)
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Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services...
This requirement is not met as evidence by:
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The Licensee has agreed and will read the entire Health Related Services regulation will train staff in the above regulation and will ensure to provide transportation as indicated in client’s admission agreement. Licensee will provide acknowledgement of understanding signed by all staff. Acknowledgement will be sent via email to LPA by POC date 10/17/2025.
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Based on observations, interviews and record review, the licensee did not ensure Health related services to be provided to 1 out of 1 client in care. Which poses an immediate Health, Safety, or Personal Rights risk to clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 56-AS-20250702161225
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: ST. CLARE FAMILY HOME
FACILITY NUMBER: 361881272
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/09/2025
Section Cited
HSC
87468.1(a)(2)
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Personal Rights of Residents in All Facilities....(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment..

This requirement is not met as evidence by:
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The Licensee has agreed and will read the entire personal rights regulation regarding recreational activities and provide the transportation. Licensee will provide an updated activity calendar and implement community based outings for clients.Licensee will provide acknowledgement of understanding signed by all staff. Acknowledgement will be sent via email to LPA by POC date 10/8/2025.
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Based on observation, interviews, and record review, the licensee did not ensure to follow Personal Rights regulation to 4 out of 4 clients in care, which poses a potential health, safety, or personal rights risk to clients in care
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Type A
10/08/2025
Section Cited
HSC
87468.1(2)(5)
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Personal Rights of Residents in All Facilities.. (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment... (5) To have the freedom to attend religious services or activities of their choice either in or outside the facility and to have visits from the spiritual advisor of their choice. Attendance at religious services, either in or outside the facility, shall be on a completely voluntary basis.
This requirement is not met as evidence by:
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Licensee has agreed to read over the Personal Rights Regulation pertaining to providing safe, healthful and comfortable accommodations, furnishings and equipment to C#2. Lincensee will determine if facility can meet C#2 needs based on provding a wheelchair adaptive vehicle that will meet C#2 needs. Licensee will provide LPA with a plan and email a copy of the plan to LPA by POC date 10/8/2025
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Based on observation, interviews, and record review, the licensee did not ensure to follow Personal Rights regulation to C#2, which poses a potential health, safety, or personal rights risk to clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
07/02/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250702161225

FACILITY NAME:ST. CLARE FAMILY HOMEFACILITY NUMBER:
361881272
ADMINISTRATOR:SANCHEZ,ANTONIOFACILITY TYPE:
735
ADDRESS:2608 GARFIELD AVENUETELEPHONE:
(909) 295-9740
CITY:ONTARIOSTATE: CAZIP CODE:
91761
CAPACITY:4CENSUS: 4DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Antonio SanchezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator is not at the facility the required amount of time.
Licensee does not ensure that a designated substitute is present at the facility during Administrator's absence.
Licensee is not ensuring that staff are informing resident's authorized representative of activities related to resident's care and supervision.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Antonio Sanchez and explained the purpose of the visit. The investigation consisted of interviews, review of records, and observations.

First allegation: Administrator is not at the facility the required amount of time. Regarding the allegation LPA conducted interviews with S#2, S#3, and S#4, LPA went over the allegation with staff, and three out of three staff informed LPA that the Facility Administrator is at the facility for enough time. In addition, S#2-4 informed LPA that the facility administrator is always available when needed. During the visit LPA observed that Administrator was present at the time of the visit. LPA conducted an interview with facility administrator who informed LPA that based on title 22 the administrator is at the facility for a sufficient amount of time to ensure that the facility is operating appropriately. LPA conducted an interview with C#2 and C#3 regarding the allegation and C#2 and C#3 informed LPA that the Administrator is at the facility often and available for clients involving any concerns at the facility.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20250702161225
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: ST. CLARE FAMILY HOME
FACILITY NUMBER: 361881272
VISIT DATE: 10/08/2025
NARRATIVE
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Second allegation: Licensee does not ensure that a designated substitute is present at the facility during Administrator's absence. Regarding the allegation LPA conducted interviews with S#2, S#3, and S#4, LPA went over the allegation with staff, and three out of three staff informed LPA that the Facility Administrator has a designated substation during the times that the Administrator is out for emergencies or on vacation. LPA conducted a file and personnel review and observed that the facility currently has designated staff that are clear and eligible to substitute during administrators’ absence.

Third allegation: Licensee is not ensuring that staff are informing resident's authorized representative of activities related to resident's care and supervision. Regarding the allegation, LPA conducted an interview with Staff #1 pertaining to the allegation stated above, Staff #1 denied the allegation and informed LPA that the facility ensures to inform all parties involving clients care, and supervision. LPA conducted interviews with S#2, S#3, and S#4, and all informed LPA that staff communicate and report all incidents that involve the care and supervision of each client in care. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations 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 (LIC 9099) was discussed, and a copy was provided to Facility Administrator Antonio Sanchez at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6