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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530104
Report Date: 12/17/2024
Date Signed: 12/17/2024 10:12:12 AM

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
11/07/2024 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241107111607
FACILITY NAME:JUBILEE HOMEFACILITY NUMBER:
365530104
ADMINISTRATOR:JADA GUTIERREZFACILITY TYPE:
735
ADDRESS:13493 JUBILEE PL.TELEPHONE:
(760) 780-0026
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:3CENSUS: 1DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Joseph Obadahun, AdministratorTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Licensee does not ensure staff are awake at all times to provide care and supervision to clients.
INVESTIGATION FINDINGS:
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On 12/17/2024 at 9:30 PM, Licensing Program Analyst (LPA) Eldin Serrano arrived at the facility to investigate a complaint and deliver the findings for the above complaint allegation. Upon arrival, LPA met with Administrator Joseph Obadahun, and LPA informed Administrator Obadahun of the purpose of the visit. The investigation consisted of file review, interviews with staffs as well as observation.
The investigation was conducted by LPA Serrano. The investigation consisted of records review and interviews with relevant parties. The allegations indicated that:

Licensee does not ensure staff are awake at all times to provide care and supervision to clients – Based on the interview with staff #1 (S1). Staff stated that he was cooking and attending to the client when the phone rang and staff #1 was not able to answer the phone right away.

*** Continuation in LIC9099C **
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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-20241107111607
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: JUBILEE HOME
FACILITY NUMBER: 365530104
VISIT DATE: 12/17/2024
NARRATIVE
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 Furthermore, during the interview with the client #1 (C1), C1 stated that he was only joking when C1 called C1’s mom and told her that staff was sleeping. C1 stated that the allegation was not true, C1 stated he was fed, and his diapers was changed by S1. C1 stated he was just kidding.

LPAs did not find evidence to corroborate the allegation.

Based on the evidence, Licensee does not ensure staff are awake at all times to provide care and supervision to clients is UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted with this report, LIC9099 was discussed and provided to Administrator Joseph Obadahun.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
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