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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530119
Report Date: 10/11/2024
Date Signed: 10/11/2024 03:09:47 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
10/07/2024 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241007112945
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: 96DATE:
10/11/2024
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Tammy Chavez, Resident Care CoordinatorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staffs are stealing residents mail.
INVESTIGATION FINDINGS:
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On 10/11/2024 at 9:55 AM, 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 Serrano met with Resident Care Coordinator (RCD) Tammy Chavez, and LPA Serrano informed RCD Chavez of the purpose of the visit. The investigation consisted of file review, interviews with staffs and clients as well as observation.

The investigation was conducted by LPA Serrano. The investigation consisted of records review and interviews with relevant parties. The allegation indicated that Staffs are stealing residents mail. During the investigation, LPA 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: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
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-20241007112945
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: 10/11/2024
NARRATIVE
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Interviews with eleven (11) of eleven (11) clients indicated that there is no mail stolen and the staffs are not stealing clients mail. Clients interviewed reported that the mail can only be accessed and claimed through the front desk where the security guard is stationed. Security guard receives the mail from the mailman as an incoming mail and they are the one who distributes the mail to the clients. Interviews with six (6) of six (6) staffs indicated that the mail are being distributed by the security guard and no one is allowed to touch the mail behind the front desk counter except for the security/staff in charge. Six (6) of six (6) staff interviews revealed that there’s no incident that happened in the facility that staff steal clients mail. During the visit on 10/11/2024, LPA Serrano observed that the head of security is the one safeguarding and handling the mail for the clients.

Based on the evidence, the allegation that Staffs are stealing residents mail 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 Residence Care Coordinator Tammy Chavez.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
LIC9099 (FAS) - (06/04)
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