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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530086
Report Date: 02/12/2025
Date Signed: 02/12/2025 01:57:19 PM

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
12/23/2024 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241223143816
FACILITY NAME:HIS HOUSEFACILITY NUMBER:
365530086
ADMINISTRATOR:BEATRICE, DANIELLEFACILITY TYPE:
772
ADDRESS:1354 CARLOS PLACETELEPHONE:
(909) 519-0767
CITY:ONTARIOSTATE: CAZIP CODE:
91764
CAPACITY:6CENSUS: 0DATE:
02/12/2025
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Licensee-Glenn Swanson Carol SwansonTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee did not maintain facility in good repair.
INVESTIGATION FINDINGS:
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On 02/12/2025,Licensing Program Analyst (LPA) Beena Singh made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Singh was greeted and granted entry by Facility Licensee Carol and Glenn Swanson. LPA Singh explained the purpose of the visit. The investigation consisted of file review, reports, interviews with Licensee, staffs, and reporting party as well as observation.
The investigation was conducted by LPA Singh. The investigation consisted of file review and interviews with relevant parties.

The first allegation indicates facility Licensee did not maintain facility in good repair.
During the investigation, LPA Singh did not find evidence to corroborate the allegation. Interviews with Reporting party and Staffs indicated that Staff reported a bad smell in the dishwasher to the Program Manager (PM). The PM informed maintenance about client complaints regarding the smell. A repairman fixed the issue on 12/20/24, stating there was no mold but advising running the dishwasher with cleaner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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-20241223143816
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: HIS HOUSE
FACILITY NUMBER: 365530086
VISIT DATE: 02/12/2025
NARRATIVE
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Detailed Results of the Air Sample Analysis Report indicated no mold growth indoors and as per report outdoor mold growth is more likely to pose health hazard then indoors. LPA Singh observed facility is clean and no signs of mold growth at the time of visit. No residents were present at the time of visit to the facility. Facility is temporarily closed due to staffing issues.

Based on the evidence gathered during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted where this report, LIC9099, LIC 9099C were discussed and provided to Facility Licensee Carol and Glenn Swanson.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2