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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530119
Report Date: 08/13/2024
Date Signed: 08/13/2024 12:53:57 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/31/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240731121757

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: 90DATE:
08/13/2024
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Jessica Langston- Associate DirectorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff do not safeguard resident's personal belongings.
Staff yell at resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Jessica Langston and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff do not safeguard resident's personal belongings. LPA conducted interviews with staff during interviews all staff denied taking Client #1 belongings along with mail in addition, staff also denied witnessing staff take Client #1 belongings. LPA conducted interviews with clients and 4 out of 5 clients denied taking or witnessing Client #1 personal belongings being taken. LPA conducted an interview with Staff #1 who stated that all clients fill out an inventory sheet and list all their personal belongings. In addition, Staff #1 also stated that the facility has a theft and loss prevention program in place for clients. Staff #1 stated that Client #1 filled a theft report on 6/30/2024, indicating that Microsoft files were taken however, Staff #1 indicated that on that same day 6/30/2024, Client #1 stated that Microsoft files were found.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20240731121757
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JC WALLACE HOUSE ADULT RESIDENTIAL COMMUNITY
FACILITY NUMBER: 365530119
VISIT DATE: 08/13/2024
NARRATIVE
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Second allegation, Staff yell at resident in care. LPA conducted interviews with staff pertaining to the allegation "staff yell at resident in care", and all staff denied yelling at Client#1 and denied witnessing staff yelling at Client#1. LPA conducted interviews with clients and 4 out of 5 clients denied being yelled at or mistreated by staff. In addition, 4 out of 5 clients denied witnessing Client #1 being yelled at or mistreated by staff. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Jessica Langston.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4