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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426795
Report Date: 06/05/2025
Date Signed: 06/05/2025 04:48:13 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
03/28/2025 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250328135548
FACILITY NAME:HANA HOMEFACILITY NUMBER:
366426795
ADMINISTRATOR:DARLENE M. MORENOFACILITY TYPE:
735
ADDRESS:11649 IVY AVENUETELEPHONE:
(760) 669-2024
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:4CENSUS: 4DATE:
06/05/2025
UNANNOUNCEDTIME BEGAN:
04:30 PM
MET WITH:Marco AllenTIME COMPLETED:
04:52 PM
ALLEGATION(S):
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Staff mentally abuse clients in care
Staff do not interact with clients in a dignified manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA was granted entry and met with Marco Allen, Direct Support Professional (DSP). The investigation consisted of LPA observations and interviews with pertinent parties.

Regarding the allegation, staff mentally abuse clients in care, interviews with four (4) staff deny they mentally abuse clients in care. Interviews with three (3) out of four (4) clients deny being mentally abused by staff.

Regarding the allegation, staff do not interact with clients in a dignified manner, interviews with four (4) staff deny interacting with clients in an undignified manner. Interviews with three (3) out of four (4) clients deny that staff interact with them in an undignified manner.

Based on this investigation, the allegations are Unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2025
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-20250328135548
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: HANA HOME
FACILITY NUMBER: 366426795
VISIT DATE: 06/05/2025
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 provided with appeal rights to DSP Allen at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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