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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423728
Report Date: 11/02/2021
Date Signed: 11/02/2021 03:25:13 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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2021 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211028114439
FACILITY NAME:GOLDEN CASCADEFACILITY NUMBER:
366423728
ADMINISTRATOR:DANIEL RESCIAFACILITY TYPE:
740
ADDRESS:15453 ELM LANETELEPHONE:
(909) 606-8719
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:6CENSUS: 4DATE:
11/02/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Benilda OrilaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff inappropriately touched resident

Staff yelled at resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Javier Prieto and LPA Rohit Lama arrived at the facility to conduct a complaint investigation regarding an allegation that: Staff inappropriately touched resident and Staff yelled at resident. LPAs met with Benilda Orila and Butch DeLa Cruz. LPA interviewed Resident #1 (R1). R1 states that the staff did not Staff inappropriately touched resident nor did they Staff yelled at resident. Staff #1 was interviewed and stated the same. LPAs obtained documentation regarding the incident report; satisfying reporting requirements for Title 22 Regulations.

Based on the information obtained there is not enough evidence that: Staff inappropriately touched resident or Staff yelled at resident. Therefore, the allegations that: Staff inappropriately touched resident and Staff yelled at resident, is deemed UNSUBSTANTIATED at this time. 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.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: 9512480349(323) 981-3968
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2021
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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