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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425801613
Report Date: 11/29/2021
Date Signed: 11/29/2021 04:26:41 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2021 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20211103151605
FACILITY NAME:UCP-WORK,INC-SLOAN TERRACEFACILITY NUMBER:
425801613
ADMINISTRATOR:EDWARD MALDONADOFACILITY TYPE:
735
ADDRESS:824 EAST SLOAN TERRACETELEPHONE:
(805) 937-0360
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:4CENSUS: 4DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Edward Maldonado, House ManagerTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Conduct Inimical
INVESTIGATION FINDINGS:
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On 11/29/2021 at 2:40 pm, Licensing Program Analyst (LPA) Chavez initiated a complaint visit to discuss the final findings for the allegation listed above. LPA met with Edward Maldonado, Residential Services Program Manager / House Manager, and informed him of the reason for the visit.

On the allegation “Conduct Inimical”, the concern was that management was requesting staff to falsify documents. LPA investigated the allegation by interviewing Pamela Holcombe, Director of Residential Services and Edward Maldonado, on 11/09/21 between 12:23 pm and 1:00 pm, interviewed five staff on 11/09/21 between 11:17 am and 4:00 pm, and reviewed resident records on 11/12/21 at 4:15 pm.

Continued on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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 29-AS-20211103151605
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: UCP-WORK,INC-SLOAN TERRACE
FACILITY NUMBER: 425801613
VISIT DATE: 11/29/2021
NARRATIVE
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Continued from 9099.

Interviews reveal that management requested documentation from staff, however, no requests were made for fabricating records. Interviews indicate that some staff were late in recording resident information, and that it was completed upon request by supervisor. Resident records show that staff are complying with Tri-Counties Regional Center requirements for documentation.

Based on evidence obtained, the allegation “Conduct inimical” was found to be Unsubstantiated.

An exit interview was conducted with Edward Maldonado and a copy of the report emailed.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2