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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426348
Report Date: 05/12/2025
Date Signed: 05/12/2025 12:50:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
04/08/2025 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20250408113246
FACILITY NAME:SAFEGUARD ADULT HOME IFACILITY NUMBER:
366426348
ADMINISTRATOR:BAYSINGER, ROYFACILITY TYPE:
735
ADDRESS:12779 2ND AVENUETELEPHONE:
(951) 544-2135
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:6CENSUS: 3DATE:
05/12/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Roy Baysinger, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Lack of Care and Supervision
INVESTIGATION FINDINGS:
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On 5/12/2025 at 10:50 AM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility to deliver the findings of the above allegations. LPAs met with administrator Roy Baysinger to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staffs and residents as well as facility observation.

Allegation: Lack of Care and Supervision – Based on observation, file review and interview, the facility has a staff present when the reporting party (RP) arrived at the facility. Interviews with staff #1 (S1) and staff #2 (S2) both indicated that S1 was there in the facility to fill in for any gaps in staff schedule when S2 is not in the facility. Based on record review it indicated that S1 is in the provided facility roster and has a criminal record clearance. The administrator provided the staff schedule that showed that there is enough coverage for care and supervision of the clients. Information received during investigation did not corroborate with the allegation.

*** Continuation in LIC9099C ***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
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-20250408113246
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SAFEGUARD ADULT HOME I
FACILITY NUMBER: 366426348
VISIT DATE: 05/12/2025
NARRATIVE
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During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Administrator Roy Baysinger.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2