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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530119
Report Date: 08/28/2024
Date Signed: 04/27/2025 07:23:32 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
11/27/2023 and conducted by Evaluator Lavette Farlow
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231127133521
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: 95DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Jessica Langston, Associate Director TIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
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9
Staff did not allow resident to receive confidential calls.
INVESTIGATION FINDINGS:
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***This is an amended report to correct LIC9099 dated and signed on 08/28/2024***

Licensed Program Analyst (LPA) Lavette Farlow and Licensing Program Manager (LPM) Nedra Brown conducted an unannounced visit to the facility to conclude the complaint investigation and deliver findings for the allegation listed above. LPA Farlow and LPM Brown were greeted and granted entrance by Staff/Security Karen Castenada. LPA Farlow and LPM Brown met with Jessica Langston Associate Director and discussed the purpose of the visit.

LPA Farlow and LPM Brown conducted a tour of the facility, interviewed staff, and interviewed clients. LPA Goldenberg conducted staff and resident interviews on a previous visit.

It is alleged that staff did not allow resident to receive confidential calls. The investigation consists of file review, observation, and interviews with relevant parties. Interviews with fourteen (14) out of fourteen (14) residents revealed that the residents are allowed to receive and make phone calls and have privacy in the facility private dining room.

Interviews with four (4) of four (4) staffs indicated that all their residents are allowed to receive confidential calls, and the calls are transfer to the private dining room.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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-20231127133521
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: 08/28/2024
NARRATIVE
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Based on observations and interviews conducted with staff and residents, the allegation that staff did not allow resident to receive confidential calls 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.

Exit interview conducted where this report LIC 9099C was discussed, and a copy was provided to Jessica Langston Associate Director.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2