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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426354
Report Date: 05/03/2024
Date Signed: 05/03/2024 01:49:52 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
01/18/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240118113547
FACILITY NAME:XAVIER FAMILY HOMEFACILITY NUMBER:
366426354
ADMINISTRATOR:CARDEN, LORIFACILITY TYPE:
735
ADDRESS:9255 PALM LANETELEPHONE:
(909) 574-8129
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:6CENSUS: 4DATE:
05/03/2024
UNANNOUNCEDTIME BEGAN:
01:14 PM
MET WITH:LaPorsha GrantTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are verbally abusing clients while in care.
Staff are providing care and supervision while under the influence of illegal drugs and or alcohol.
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 Facility House Manager LaPorsha Grant and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff are verbally abusing clients while in care.

LPA conducted interview with clients and during interviews LPA asked clients if they are being verbally abused or mistreated by staff, all clients stated that they are not being mistreated or verbally abused by staff. LPA asked clients if they have witnessed staff mistreat or verbally abuse clients in care, all clients denied witnessing staff mistreat or verbally abuse clients in care. LPA conducted interviews with staff LPA asked staff if they are mistreating or verbally abusing clients in care all staff denied mistreating and verbally abusing clients. LPA asked staff if they have witnessed staff mistreat or verbally abuse clients in care, all staff denied witnessing staff mistreat or verbally abuse clients in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
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-20240118113547
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: XAVIER FAMILY HOME
FACILITY NUMBER: 366426354
VISIT DATE: 05/03/2024
NARRATIVE
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Second allegation, Staff are providing care and supervision while under the influence of illegal drugs and or alcohol. LPA conducted interviews with clients regarding staff being under the influence of illegal drugs or alcohol while providing care, all clients denied witnessing staff being under the influence of illegal drugs or alcohol. In addition, clients denied smelling the odor of alcohol or illegal drugs on staff while providing care. LPA conducted interviews with staff regarding staff being under the influence of illegal drugs or alcohol while providing care, all staff denied being under the influence of illegal drugs or alcohol while providing care and supervision. In addition, staff denied witnessing staff being under the influence of illegal drugs and alcohol. In addition, staff denied smelling the odor of illegal drugs or alcohol on staff while providing care and supervision. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

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 Facility Manager LaPorsha Grant.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2