547209231-4-25-2026-24-AS-AWAN-DTUTUZ-20260507150306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 547209231
Report Date: 04/25/2026
Date Signed: 04/25/2026 05:41:31 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/21/2026 and conducted by Evaluator Brianna Miranda

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20260121093511

FACILITY NAME:	DE BOER HOME #1		FACILITY NUMBER:	547209231
ADMINISTRATOR:	DE BOER, BREANN		FACILITY TYPE:	735
ADDRESS:	1030 N BELMONT		TELEPHONE:	(559) 350-3695
CITY:	PORTERVILLE	STATE: CA	ZIP CODE:	93257
CAPACITY:	4	CENSUS: 5	DATE:	04/25/2026
		UNANNOUNCED	TIME BEGAN:	05:30 PM
MET WITH:	Jasmine Mata- Caregiver		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff handled resident aggressively.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On April 25, 2026, Licensing Program Analyst (LPA) B. Miranda arrived at the facility unannounced to deliver the findings for the allegation listed above. LPA met with Jasmine Mata- Caregiver.

Regarding the allegation: Facility staff handled resident aggressively. LPA conducted various interviews and tried to obtain evidence regarding the allegation. Interviewees did not state S1 staff was aggressive in any way to residents.

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, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided to Jasmine Mata- Caregiver

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Brianna Miranda
LICENSING EVALUATOR SIGNATURE:	DATE: 04/25/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2026

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 1