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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 502700646
Report Date: 04/12/2022
Date Signed: 04/12/2022 05:21:05 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2022 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20220113110852
FACILITY NAME:CLAREMONT HOMEFACILITY NUMBER:
502700646
ADMINISTRATOR:HUDDLESTON, DOLORESFACILITY TYPE:
735
ADDRESS:3324 CLAREMONT AVENUETELEPHONE:
(530) 515-9078
CITY:MODESTOSTATE: CAZIP CODE:
95350
CAPACITY:4CENSUS: 3DATE:
04/12/2022
UNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Staff Crystal BernalTIME COMPLETED:
04:21 PM
ALLEGATION(S):
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Staff does not properly supervise residents
Licensee does not ensure resident attends school
Facility does not meet residents' nutritional needs
Facility does not provide activities for resident
Licensee does not follow menu
INVESTIGATION FINDINGS:
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LPA Jason Lund arrived at the above address to conduct a complaint visit to delivery finding to the facility regarding the above allegation. LPA spoke with Dolores Huddleston who could not make, and staff Crystal Bernal will be signing for the Administrator.

Staff does not properly supervise residents - Based on, facility reports and interviews with witnesses, Claremont staff and clients the facility has sufficient staffing for the clients in care. Based on interviews with Valley Mountain Regional Center the facility doesn’t have any clients who needs one on one care. There is no staffing ratio for the clients in care. The facility does have to have awake staff at night and records indicate that the facility does have awake staff. When the facility does outings for the clients the facility will have additional staffing for the clients in care. The facility uses a monthly board for scheduling the staff but is not always filled out correctly, do to staff quitting and not showing up for work. Administrator Dolores Huddleston doesn’t put herself on the schedule and fill in as necessary for scheduling conflicts. The facility doesn’t have a place for staff to sleep and Administrator Dolores Huddleston denied that staff sleep at night.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
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 2
Control Number 27-AS-20220113110852
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: CLAREMONT HOME
FACILITY NUMBER: 502700646
VISIT DATE: 04/12/2022
NARRATIVE
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Licensee does not ensure resident attends school- Based on Interviews with Valley Mountain Regional Center, Administrator Dolores due to the pandemic and Client (C1) moving in May of 2021 and the day programs not yet being open completely. C1 has not been able attend a day program but Regional Center and the facility are still looking for a proper day program for C1.

Facility does not meet residents' nutritional needs & Licensee does not follow menu- LPA observed on multiple visits conducted that there is more than an adequate supply of both perishable and non-perishable foods for the three residents in care. The facility has a monthly schedule (menu) but does change meals when clients would like something different on that particular day.

Facility does not provide activities for resident- LPA observed a Monthly Activity Board for the month of April 2022 with different activities for the clients in care such as board games, picnic in the backyard and arts & crafts. Since the COVID pandemic has gotten less restrictive the facility does go on day trips, and to the San Francisco Giants game.

The Department (CCLD) has found the allegations, Unsubstantiated. A finding that the complaint allegation(s) is UNSUBSTANTIATED means that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.
Exit interview was conducted over the phone with Administrator Dolores Huddleston and signed by staff Crystal Bernal.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2