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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366400113
Report Date: 05/21/2024
Date Signed: 05/21/2024 12:03:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/17/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240517122229
FACILITY NAME:GARDENFACILITY NUMBER:
366400113
ADMINISTRATOR:MICHAEL BRLETICHFACILITY TYPE:
735
ADDRESS:9212 GARDEN STREETTELEPHONE:
(909) 941-4449
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 4DATE:
05/21/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Mike Brlitich, AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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9
Staff do not ensure that a resident's needs are met during the night
Staff speak inappropriately to a resident
Licensee does not accommodate resident with a comfortable bed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above-mentioned allegations. LPA Prieto met with Administrator Mike Brlitich, allowed entry and interviewed two residents at time of interview. LPA Prieto explained the elements of the complaint.

Regarding the allegation staff do not ensure that a resident's needs are met during the night; LPA interviewed staff #1 (S1) who states residents engage normal activities such as listening radio and playing video games and added that once told to stop activities, the residents abide with request during evening hours. Resident #1 (R1) and R2 were interviewed and stated that evening activities are concluded once asked to respect other resident's in the home.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
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-20240517122229
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: GARDEN
FACILITY NUMBER: 366400113
VISIT DATE: 05/21/2024
NARRATIVE
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Regarding the allegation staff speak inappropriately to a resident; interviews with R1 and R2 state that staff does not speak to residents in an inappropriate manner. Interview with S1 states that residents are not spoken to in an inappropriate manner. Interview with Administrator states that language use by resident's and staff have been addressed and found not to be inappropriate.

Regarding allegation that Licensee does not accommodate resident with a comfortable bed; LPA observed client in question bed and found that all beds, for each resident are full size, double pillow top with memory form. None of the residents in the home require a special needs bed.

Based on the information obtained there is not enough evidence that staff do not ensure that a resident's needs are met during the night, staff speak inappropriately to a resident and Licensee does not accommodate resident with a comfortable bed. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Brlitich and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2