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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426354
Report Date: 02/03/2026
Date Signed: 02/03/2026 12:28:34 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
01/08/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260108153353
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: 5DATE:
02/03/2026
UNANNOUNCEDTIME BEGAN:
11:57 AM
MET WITH:LaPorsha GrantTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Client tested positive for fentanyl while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Manager LaPorsha Grant and explained the purpose of the visit regarding the allegations stated above.

First allegation: Client tested positive for fentanyl while in care. Regarding the allegation stated above, LPA conducted an interview with Staff #1, LPA went over the alleged allegation with Staff #1, and Staff #1 informed LPA that on 12/24/2025 Client #1 was admitted to San Bernardino Community Hospital. Staff #1 further stated that on Friday 12/26/2025 Hospital Case Worker contacted the facility to inform that Client #1 had tested positive for Fentanyl/PCP, however, SBC-Hospital did not provide the facility with test results. Staff #1 further explained that upon Client #1 discharge on 12/29/2025, Client #1 was taken to LabCorp by staff for drug testing. On 1/2/2026, LabCorp results showed that Client #1 tested negative for the following: Fentanyl/ Analogues Negative; Fentanyl: Not detected.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
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-20260108153353
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: 02/03/2026
NARRATIVE
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During the review of Client #1 discharge records, LPA observed that there was no evidence listed that SBC-Hospital conducted a drug test on Client #1. LPA conducted an interview with Consumers Services Coordinator (CSC), Liaison at Inland Regional Center, regarding the allegation stated above. CSC informed LPA that the Hospital had indicated that paperwork/results would be provided upon Clients discharge, however, CSC informed LPA that upon receiving Client#1 discharge paperwork that the drug test was not provided. Furthermore, CSC also informed LPA that their department also attempted to collect documents, however, they were unable to obtain the documents. Based on corroborating evidence, the department has determined that the above allegation is 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: 02/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2