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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413177
Report Date: 06/01/2023
Date Signed: 06/01/2023 11:45:58 AM

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
05/26/2023 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230526144929
FACILITY NAME:D'ADAMS FAMILY CAREFACILITY NUMBER:
366413177
ADMINISTRATOR:PANOPIO, LEODIGAERLFACILITY TYPE:
735
ADDRESS:11665 CIBOLA ROADTELEPHONE:
(760) 240-1471
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92308
CAPACITY:5CENSUS: 4DATE:
06/01/2023
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Leo and Concepcion Panopio, LicenseesTIME COMPLETED:
11:50 AM
ALLEGATION(S):
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9
Staff is verbally abusive to residents while in care.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to initiate a complaint investigation and deliver the finding on the above allegation. LPA met with Licensees Leo and Concepcion Panopio and explained the purpose of the visit. The investigation included a facility tour, file reviews, and interviews with relevant parties.

The allegation alleged that resident #1 (R1) stated to the reporting party (RP) that staff # 1 (S1) is mean. The allegation alleged that S1 yelled at another resident in care, telling them to be quiet and return to their room. LPA Nickolas’ interviews with the Licensees revealed that they denied the allegation. The Licensees stated that they have never received reports from any residents about being yelled at. LPA Nickolas' interview with a resident in care, revealed that they denied the allegation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
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-20230526144929
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: D'ADAMS FAMILY CARE
FACILITY NUMBER: 366413177
VISIT DATE: 06/01/2023
NARRATIVE
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An exit interview was conducted and copy of this report was provided.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2