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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880810
Report Date: 11/17/2022
Date Signed: 11/17/2022 12:13:58 PM

Unfounded


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
11/14/2022 and conducted by Evaluator Janira Arreola
COMPLAINT CONTROL NUMBER: 18-AS-20221114152101
FACILITY NAME:GREEN MERRYLANDS MURRIETA HOMEFACILITY NUMBER:
331880810
ADMINISTRATOR:ZHAO, NAFACILITY TYPE:
740
ADDRESS:40052 DAPHNE DRIVETELEPHONE:
(909) 994-6204
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 1DATE:
11/17/2022
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Brandon Marquez, AdministratorTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff do not have running water for the residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility on 11/17/2022 at 9:15 a.m. LPA met with Brandon Marquez, Administrator, and spoke with Licensee Na Zhoa over the phone, and informed them of the purpose fo the visit.

Regarding allegation “Staff do not have running water for the residents“, LPA conducted a walkthrough of the facility, documented observations and conducted interviews. LPA was informed by the city water district on 11/16/2022 that the facility has running water and their account balance is up to date. LPA observed the facility had running water in all (3) restrooms, showers, and kitchen. LPA conducted interview with staff present who stated that the facility has running water, and that the complaint may have been in error as the licensee has another facility Kun Bai Care #2 that did not have running water. LPA also interviewed the licensee over the phone who stated that the fcaility has running water and that her account is being paid through autopay.


Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
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 18-AS-20221114152101
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: GREEN MERRYLANDS MURRIETA HOME
FACILITY NUMBER: 331880810
VISIT DATE: 11/17/2022
NARRATIVE
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Therefore, based on the interview and observations, the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted where this report was reviewed and provided to Brandon Marquez, Administrator
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3