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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530119
Report Date: 04/02/2024
Date Signed: 04/02/2024 01:22:23 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
03/25/2024 and conducted by Evaluator Bianca Wolcott
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240325085000
FACILITY NAME:JC WALLACE HOUSE ADULT RESIDENTIAL COMMUNITYFACILITY NUMBER:
365530119
ADMINISTRATOR:BRITTANY KAVANAUGHFACILITY TYPE:
735
ADDRESS:22325 BARTON RD.TELEPHONE:
(909) 420-0153
CITY:GRAND TERRACESTATE: CAZIP CODE:
92313
CAPACITY:150CENSUS: 68DATE:
04/02/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Tammy Chavez (Acting Supervisor)TIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Staff is not present for a sufficient number of hours
Staff are forcing the clients to clean the facility grounds
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bianca Wolcott conducted an unannounced visit to the facility to investigate the above allegations. LPA stated the purpose of the visit, and met with Tammy Chavez (Acting Supervisor). Shortly after another staff said Rajdeep Thandi (Chief Complaince Office) wanted to be on speaker and speak to me about complaint. I went over allegations with Tammy Chavez and Rajdeep Thandi. The investigation consisted of resident interviews, staff interviews, and document review.

Allegation #1, Staff is not present for a sufficient number of hours:
During staff interviews, 4 out of 4 staff stated that daily including night shift, they have between 13 - 22 employees working. Administrator works every week on Wednesday, Thursday & Friday, sometimes more. During client's interviews, 7 out 7 clients stated there are always staff at facility. Staff is always at facility and willing to help.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Bianca Wolcott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
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-20240325085000
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: JC WALLACE HOUSE ADULT RESIDENTIAL COMMUNITY
FACILITY NUMBER: 365530119
VISIT DATE: 04/02/2024
NARRATIVE
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Allegation #2, Staff are forcing the clients to clean the facility grounds.
During staff interviews, 4 out of the 4 Staff stated that facility has a program they started (2) weeks ago. Program is on a voluntary basis which consists with working with clients to get back to daily life skills. The tasks they can help with in the dining area which consists of: wiping down tables in dining room, clean coffee area, mop dining room, sweep dining room, empty trash, and tidy activity room. Clients are allowed to pick what job they would like to do. After the (2) week program facility gives menus to clients from different restaurants in which they can pick a meal that facility pays for. Every (2) weeks another set of clients can participate if they like. Housekeeping is at the facility daily Monday-Sunday, which consists of 2-3 employees. LPA observed (2) housekeepers at facility cleaning. During client's interviews, 7 out of 7 client's stated Housecleaning cleans the facility. Interviews with 7 out of 7 client's stated staff never make them clean or ask them to clean for food. During client interview's 7 out of 7 client's were aware of the client program of helping out in the dining room for the free meal every (2) weeks.

Based on the information revealed during the investigation, LPA Wolcott did not find evidence to corroborate the allegations, these allegations are therefore unsubstantiated. A finding of 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. An exit interview was conducted with Tammy Chavez (Acting Supervisor), and a copy of this report was provided.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Bianca Wolcott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2