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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425506
Report Date: 12/12/2023
Date Signed: 12/12/2023 01:57:38 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
12/06/2023 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20231206131343
FACILITY NAME:YUCAIPA ADULT DAY CENTERFACILITY NUMBER:
366425506
ADMINISTRATOR:MURRAY, SHARANFACILITY TYPE:
775
ADDRESS:12980 2ND STREETTELEPHONE:
(909) 790-4012
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:49CENSUS: 34DATE:
12/12/2023
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Annalisa Sialana,-Administrator Assistan TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff handle clients in a rough manner.
Staff did not meet clients’ diapering needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the allegations above. LPA Allen met with Annalisa Sialana, who was informed of the purpose of the visit.

LPA conducted interviews with staff who stated that the clients in care are changed throughout the day and/or as needed. Staff have also stated clients are body checked upon arrival and departure to make sure diapering is not required and their needs have been met prior to leaving the facility.
Staff were also asked about clients being treated in a rough manner and all staff members stated clients are treated with care and they have not observed or heard of any other staff member treating clients in a rough manner.
LPA interviewed responsible parties of residents and they have stated their clients have not been treated in a rough manner. The clients are body checked upon arrival from the facility and there has not been any concerns.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
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-20231206131343
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: YUCAIPA ADULT DAY CENTER
FACILITY NUMBER: 366425506
VISIT DATE: 12/12/2023
NARRATIVE
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 Responsible parties have also stated clients have not returned home without their diapering needs being met. LPA observed staff assisting clients with their personal needs while at the facility.
Based on observation and interviews, the above findings are Unsubstantiated. A finding of unsubstantiated means although the allegations 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 was discussed and provided Annalisa Sialana at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2