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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372008440
Report Date: 04/29/2022
Date Signed: 04/29/2022 12:14:51 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/31/2021 and conducted by Evaluator Charmaine Linley
PUBLIC
COMPLAINT CONTROL NUMBER: 08-CR-20210831152440
FACILITY NAME:MILESTONE GROUP HOMEFACILITY NUMBER:
372008440
ADMINISTRATOR:BOONE, BEVERLY A.FACILITY TYPE:
733
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:6CENSUS: 4DATE:
04/29/2022
UNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Beverly Boone, Executive DIrector TIME COMPLETED:
12:19 PM
ALLEGATION(S):
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Staff did not safeguard minor's personal information.
INVESTIGATION FINDINGS:
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On April 29, 2022, at 12:01 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Beverly Boone, Executive DIrector, of Milestone to discuss the investigative findings for the allegation noted above. LPA Carol Anderson conducted an inspection with the facility on September 9, 2021, at 11:00 AM. No deficiencies were observed. During the investigation, LPA Carol Anderson and LPA Charmaine Linley interviewed one client (C1) and two staff (S1, S2).
On August 31, 2021, Community Care Licensing (CCL) received an allegation that staff did not safeguard the minor’s personal information. The staff is alleged to have used C1’s name and date of birth at an Independent Living Program Event for C2 to obtain a gift card. Confidential interviews revealed that S4 did use C1’s name and date of birth since they were eligible to receive a gift card, while C2 was not eligible. During this incident, C2 was able to obtain C1’s confidential birth name.
Based on confidential interviews, the preponderance of evidence standard has been met regarding the allegation that S4 did not safeguard C1’s personal information, therefore the complaint allegation is
***CONTINUED ON NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) -782-4968
LICENSING EVALUATOR NAME: Charmaine LinleyTELEPHONE: 951-202-1850
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
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 3
Control Number 08-CR-20210831152440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: MILESTONE GROUP HOME
FACILITY NUMBER: 372008440
VISIT DATE: 04/29/2022
NARRATIVE
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substantiated. This posed a potential Health, Safety, or Personal Rights risk to C3 in care, the facility will be cited for violating Interim Licensing Standards, STRTP, Article 06, 87070(g) Client Records.

A copy of this report was provided to and reviewed with Beverly Boone, Executive DIrector, along with the appeal rights and the LIC 811. A signed copy of the report will be kept in the Facility file.
SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) -782-4968
LICENSING EVALUATOR NAME: Charmaine LinleyTELEPHONE: 951-202-1850
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-CR-20210831152440
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: MILESTONE GROUP HOME
FACILITY NUMBER: 372008440
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/13/2022
Section Cited
ILS
87070(g)
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Client Records:
All information and records regarding a child shall be confidential except as otherwise authorized by law.
This requirement is not met as evidenced by: Staff giving a client another client’s name and date of birth to use to obtain a
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Per Administrator, all staff will be sent via group text not to release names of clients at public events and will review the confidentiality procedure of all clients during the 05//04/22 staff meeting, a copy of the signed agenda will be emailed to LPA.
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gift card at an Independent Living Program Event.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ann ValenzuelaTELEPHONE: (951) -782-4968
LICENSING EVALUATOR NAME: Charmaine LinleyTELEPHONE: 951-202-1850
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3