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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530119
Report Date: 09/24/2024
Date Signed: 09/24/2024 03:58:07 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
09/03/2024 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240903112250
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: 97DATE:
09/24/2024
UNANNOUNCEDTIME BEGAN:
09:25 AM
MET WITH:Jessica Langston, Executive DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff do not safeguard a client's personal belongings
INVESTIGATION FINDINGS:
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On 09/24/2024 at 9:25 AM, Licensing Program Analysts (LPA) Melody Brown and Eldin Serrano arrived at the facility to deliver the findings for the above complaint allegation. Upon arrival, LPA Brown and Serrano met with Executive Director (ED) Jessica Langston, and LPA Brown and Serrano informed ED Langston of the purpose of the visit. The investigation consisted of file review, interviews with staffs and residents as well as observation.

The investigation was conducted by LPAs Brown and Serrano. The investigation consisted of records review and interviews with relevant parties. The allegation indicates Staff do not safeguard a client's personal belongings. During the investigation, LPAs Brown and Serrano did not find evidence to corroborate the allegation.
*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 56-AS-20240903112250
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: 09/24/2024
NARRATIVE
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Interviews with ten (10) of ten (10) clients indicated that all staff at the facility are safeguarding their personal belongings. Clients interviewed reported that staffs at the facility are checking their rooms multiple times a day, staffs are ensuring that their doors are locked and there are cameras watching them. Client #1 (C1) reported that staffs at the facility are safeguarding their personal belongings because they have camera surveillance in the facility, and they all have a key to their room. Interviews with five (5) of five (5) staffs indicated that they are safeguarding their clients’ personal belongings. Five (5) of five (5) staff interviews revealed that there’s no incident that happened at the facility that a staff did not safeguard a clients’ personal belongings. During the visit on 09/06/2024 and 09/24/2024, LPAs Brown and Serrano observed staffs at the facility checking on residents’ room and providing care and supervision.

Based on the evidence, the allegation that Staff do not safeguard a client's personal belongings 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 where this report, LIC9099 was discussed and provided to Executive Director Jessica Langston.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024
LIC9099 (FAS) - (06/04)
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