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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366427079
Report Date: 07/14/2020
Date Signed: 07/14/2020 11:29:37 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/15/2020 and conducted by Evaluator Natalie Gayoso
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200615172224
FACILITY NAME:LEGACY HOUSEFACILITY NUMBER:
366427079
ADMINISTRATOR:CHALIFOUX, LYNNFACILITY TYPE:
740
ADDRESS:1791 N SECOND AVETELEPHONE:
(909) 762-9986
CITY:UPLANDSTATE: CAZIP CODE:
91784
CAPACITY:6CENSUS: 3DATE:
07/14/2020
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Lynn Chalifoux - AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff illegally evicted resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility to deliver findings for the above allegation via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Administrator, Lynn Chalifoux. The investigation consisted of interviews with relevant parties and records review.

The allegation indicated that staff illegally evicted resident. Based on an interview conducted with the reporting party, it was found that the complaint was filed in error. Reporting party did not file a complaint but instead had sent an email regarding questions they had.

This agency has investigated the above allegation and has found the complaint to be UNFOUNDED. A finding that is unfounded means the allegations are false, could not have happened, or are without a reasonable basis.


Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2020
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 18-AS-20200615172224
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: LEGACY HOUSE
FACILITY NUMBER: 366427079
VISIT DATE: 07/14/2020
NARRATIVE
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An exit interview was conducted, and a copy of this report was reviewed and provided to Ms. Chalifoux via email to obtain signature.
Receipt of report was confirmed.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2