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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425631
Report Date: 12/16/2025
Date Signed: 02/04/2026 02:45:21 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
03/01/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240301150409
FACILITY NAME:KAISER SPECIALIZED RESIDENTIAL ALTOFACILITY NUMBER:
366425631
ADMINISTRATOR:MICHAEL VAN NORMANFACILITY TYPE:
735
ADDRESS:25702 ALTO CTTELEPHONE:
(909) 883-2099
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92407
CAPACITY:4CENSUS: 4DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Michael Van Norman, AdministratorTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff are stealing clients' personal food items
Staff are financially abusing clients
Administrator is not present a sufficient number of hours to adequately manage facility
Staff threaten clients
Staff abuse clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conclude a complaint investigation regarding the above allegations. LPA Prieto met with Administrator Van Norman and explained the elements of the complaint.

Allegation #1 - LPA reviewed facility food supply during today's investigation and found to be sufficient with perishables and non perishables to meet the needs of the clients in care. LPA interviewed resident #1 (R1), R2, R3 and R4, all stated that the have enough to eat at the home and the personal food items are being safeguarded.

Allegation #2 - LPA interviewed R1, R2, R3 and R4, all stated that staff do not financially abuse them. LPA Prieto reviewed financial records for R1, R2, R3 and R4 and found them correct and up to date.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
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-20240301150409
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: KAISER SPECIALIZED RESIDENTIAL ALTO
FACILITY NUMBER: 366425631
VISIT DATE: 12/16/2025
NARRATIVE
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Allegation #3 - LPA Prieto interviewed Administrator Van Norman , who produce a facility roster, showing the Administrator is at the facility a sufficient number of hours to perform the duties of the administrator for this home.

Allegation #4 - LPA Prieto interviewed R1, R2, R3 and R4, all stating that they enjoy their stay at the facility and staff treat them with respect and are free from harm.

Allegation #5 - LPA Prieto interviewed R1, R2, R3 and R4, all stating that they enjoy their stay at the facility and staff does not abuse the clients at the home.

Based on the information obtained there is not enough evidence to support the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Van Norman and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2