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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426118
Report Date: 10/11/2023
Date Signed: 10/11/2023 11:04:13 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
09/13/2023 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230913163753
FACILITY NAME:FIRST STEP FONTANAFACILITY NUMBER:
366426118
ADMINISTRATOR:VISOR, MARYFACILITY TYPE:
775
ADDRESS:8621 JUNIPER AVE STE 101TELEPHONE:
(909) 428-6201
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:60CENSUS: 56DATE:
10/11/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Chantal Smith TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Licensee did not comply with the terms and conditions of the admission agreement.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Program Manager Chatal Smith and explained the purpose of the visit. The investigation consisted of interviews and a review of records.

First allegation, Licensee did not comply with the terms and conditions of the admission agreement. During record review LPA observed that Day Program did comply with the terms of the Admission Agreement. LPA also observed under Title 22 82068 “Admission Agreement” that the regulation indicates that a 30-day notice is to be given to the authorized representative upon a modification regarding rate change. Admission agreement does not list that a 30-day notice is to be given to the authorized representative upon the termination of the agreement. 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: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
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-20230913163753
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: FIRST STEP FONTANA
FACILITY NUMBER: 366426118
VISIT DATE: 10/11/2023
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 Program Manager Chantal Smith at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2