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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366424401
Report Date: 06/14/2023
Date Signed: 06/14/2023 11:10:20 AM

Substantiated


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
05/09/2022 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220509135333
FACILITY NAME:LMB CARE HOMEFACILITY NUMBER:
366424401
ADMINISTRATOR:BRANDON DELGADOFACILITY TYPE:
735
ADDRESS:1316 N. SAN ANTONIO AVENUETELEPHONE:
(909) 204-2722
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:6CENSUS: 3DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marilyn DelgadoTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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9
The administrator is violating the residents personal rights
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above allegation. LPA met with Facility Administrator Marilyn Delgado who was informed of the purpose of my visit and the allegation listed above. The investigation consists of direct observations, records review, and interviews regarding the above allegation.

First Allegation: The administrator is violating the residents’ personal rights.

Regarding the first allegation: The administrator is violating the residents’ personal rights. Licensing Program Analyst (LPA) Paola Guerrero interviewed Resident #1 who stated that their personal rights are being violated and asked to be home at a specific time (9:00PM). LPA interviewed Administrator, who stated that residents are expected to be home by (9:00PM), as per house rules. Resident #1 stated that because of their work schedule R#1 was not able to meet curfew.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
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 5
Control Number 56-AS-20220509135333
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: LMB CARE HOME
FACILITY NUMBER: 366424401
VISIT DATE: 06/14/2023
NARRATIVE
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 LPA Guerrero reviewed facilities Admission Agreement and observed that no mentioned curfew is listed in the agreement. Based on the evidence gathered during the investigation, the above allegation is SUBSTANTIATED.

Substantiated; A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 85072 (b) Personal Rights from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.

An exit interview was conducted where this report was discussed and provided to Facility Administrator Marilyn Delgado.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/09/2022 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220509135333

FACILITY NAME:LMB CARE HOMEFACILITY NUMBER:
366424401
ADMINISTRATOR:BRANDON DELGADOFACILITY TYPE:
735
ADDRESS:1316 N. SAN ANTONIO AVENUETELEPHONE:
(909) 204-2722
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:6CENSUS: 3DATE:
06/14/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Marilyn DelgadoTIME COMPLETED:
11:20 AM
ALLEGATION(S):
1
2
3
4
5
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9
The facility is not providing enough staffing to meet the residents needs.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above allegation. LPA met with Facility Administrator Marilyn Delgado who was informed of the purpose of the visit and the allegation listed above. The investigation consists of direct observations, records review, and interviews regarding the allegation listed above.

First Allegation: The facility is not providing enough staffing to meet the resident’s needs.

Regarding the first allegation: The facility is not providing enough staffing to meet the resident’s needs. LPA obtained a staff schedule provided by Facility Administrator LPA observed that the information was consistent and revealed that the facility has sufficient staffing support to meet resident’s needs. In addition, the Administrator is on call 24/7. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegation is UNSUBSTANTIATED.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20220509135333
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: LMB CARE HOME
FACILITY NUMBER: 366424401
VISIT DATE: 06/14/2023
NARRATIVE
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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 the Facility Administrator Marilyn Delgado at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20220509135333
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: LMB CARE HOME
FACILITY NUMBER: 366424401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2023
Section Cited
CCR
85072(b)
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Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights...

This requirement is not met as evidence by:
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Licensee has acknowledged Personal Rights Violation and has agreed to read over the entire regulation and provide a written and signed acknowledgement by all staff, understanding personal rights regulation. Acknowledgement will be emailed to LPA via Email on POC due date of 6/15/2023.
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Based on observation, interviews and record review, the licensee did not ensure Personal Rights were met which posesan immediate Health, Safety, or Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5