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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530104
Report Date: 02/28/2025
Date Signed: 02/28/2025 09:39:36 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
02/11/2025 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20250211155505
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: 2DATE:
02/28/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Jonetta Williams, House LeadTIME COMPLETED:
09:50 AM
ALLEGATION(S):
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9
Staff pushed client against the wall
INVESTIGATION FINDINGS:
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On 2/282025 at 9:05 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the House Lead Jonetta Willams. The investigation consisted of interviews with staffs and client as well as observation.The investigation was conducted by LPA Serrano. The investigation consisted of interviews with relevant parties. The allegations indicate:

Staff pushed client against the wall – Based on client and staff interviews, 4 out of 4 staff stated that they did not witness, observed, or have any knowledge of any staff or the licensee pushing a client or physically abusing any client. Client stated that the client is happy being in the facility and being treated good here.

During the investigation, LPA did not find evidence to corroborate the allegations.
*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
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-20250211155505
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: 02/28/2025
NARRATIVE
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Based on the evidence, the allegations mentioned above are 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 where this report, LIC9099 and LIC9099C were discussed and provided to the House Lead Jonetta Williams
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2