366425780-9-25-2025-56-AS-KCLS-DMVPG7-20251028111749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425780
Report Date: 09/25/2025
Date Signed: 09/25/2025 12:58:21 PM

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
09/23/2025 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250923160514

FACILITY NAME:	SPECIALIZED RESIDENTIAL LUPINE		FACILITY NUMBER:	366425780
ADMINISTRATOR:	LAWANNA JONES		FACILITY TYPE:	735
ADDRESS:	22334 LUPINE RD		TELEPHONE:	(760) 247-2391
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	4	CENSUS: 4	DATE:	09/25/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Rasheena Ross		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Staff engage in inappropriate behaviors in the presence of clients in care
Staff do not adequately supervise clients in care
Staff are not ensuring that clients are able to have their laundry needs met while in care
Staff yell at clients in care
Staff make clients stay in their rooms for extended periods of time

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with House Lead, Rasheena Ross, and informed the purpose for the visit.

Regarding allegation #1, staff engage in inappropriate behaviors in the presence of clients in care, four (4) staff interviews reveal they are not engaging in inappropriate behaviors in the presence of clients in care. LPA attempted to interview Client #1 (C1) but they did not respond to LPA’s questions. Three (3) client interviews reveal not enough evidence to corroborate the allegation that staff engage in inappropriate behaviors in the presence of clients in care.

Regarding allegation #2, staff do not adequately supervise clients in care, four (4) staff interviews reveal that staff do adequately supervise clients in care. LPA attempted to interview (C1) but they did not respond to LPA’s questions. Three (3) client interviews reveal not enough evidence to corroborate the allegation that staff do not adequatley supervise clients in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

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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Control Number 56-AS-20250923160514

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: SPECIALIZED RESIDENTIAL LUPINE	FACILITY NUMBER: 366425780
	VISIT DATE: 09/25/2025

NARRATIVE

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Regarding allegation #3, staff are not ensuring that clients are able to have their laundry needs met while in care, LPA observed clients had clean clothing and clothing were properly stored. Four (4) staff interviews reveal they are ensuring that clients are able to have their laundry needs met while in care. LPA attempted to interview (C1) but they did not respond to LPA’s questions. Three (3) client interviews reveal that staff are ensuring their laundry needs are being met while in care.

Regarding allegation #4, Staff yell at clients in care, four (4) staff interviews reveal they do not yell at clients in care. LPA attempted to interview (C1) but they did not respond to LPA’s questions. Three (3) client interviews reveal that staff do not yell at them.

Regarding allegation #5, Staff make clients stay in their rooms, four (4) staff interviews reveal they do not make client stay in their rooms. LPA attempted to interview (C1) but they did not respond to LPA’s questions. Three (3) client interviews reveal staff do not make them stay in their rooms.

Based on observations and interviews with clients and staff, the allegations are Unsubstantiated. Unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted at the conclusion of the visit. A copy of this report was provided with appeal right to House Lead Ross at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025

LIC9099 (FAS) - (06/04)

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