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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366424311
Report Date: 07/31/2024
Date Signed: 07/31/2024 10:52:31 AM

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
05/20/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240520122813
FACILITY NAME:KAISER SPECIALIZED RESIDENTIAL MERLOTFACILITY NUMBER:
366424311
ADMINISTRATOR:JAMEL CARROLLFACILITY TYPE:
735
ADDRESS:21295 MERLOT LNTELEPHONE:
(760) 240-9976
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:4CENSUS: 3DATE:
07/31/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jonetta WilliamsTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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9
Lack of supervision resulted in client eloping.
Facility staff handled client in a rough manner.
Facility staff used an unusual form of punishment.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
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9
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13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Jonetta Williams and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review.

For the allegation, Lack of supervision resulted in client eloping.

LPA Rico conducted (5) five staff interviews. 3 out of the 5 staff informed LPA that C1 had been requesting to leave the facility and no longer wanted to be part of People's Care and Inland Regional Center. In addition, 4 out of the 5 staff stated that when C1 leaves the facility they will go out and follow until they are able to return.

LPA Rico conducted (2) two client interviews. During the client interviews, LPA Rico did not find evidence to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
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-20240520122813
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: KAISER SPECIALIZED RESIDENTIAL MERLOT
FACILITY NUMBER: 366424311
VISIT DATE: 07/31/2024
NARRATIVE
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For the allegation, Facility staff handled client in a rough manner.

During staff interviews (5) five out of the (5) five staff interviews stated they have not handled their clients in a rough manner.

During client interviews (2) two out of the (2) two clients stated they have not been handled in a rough manner by staff.

For the allegation, Facility staff used an unusual form of punishment.

During staff interviews, (5) five out of the (5) staff stated they do not use anytime of punishment for their clients. (3) out of the (5) staff stated they would remind C1 to not smoke because it will affect their health. In addition, all staff stated when clients are having behaviors, they will redirect their clients.

During clients interviews. All clients stated they have not received any form of punishment.

Based on the evidence found during the investigation, the three (3) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.


An exit interview was conducted, and this report (LIC9099) was discussed and provided Administrator Jonetta Williams.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2