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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530128
Report Date: 10/25/2024
Date Signed: 10/25/2024 10:14:30 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/03/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240503162127
FACILITY NAME:EARLY BIRD CARE HOMEFACILITY NUMBER:
335530128
ADMINISTRATOR:CHANTHARASETH,PATSARAFACILITY TYPE:
740
ADDRESS:11860 CONFLUENCE DRTELEPHONE:
(657) 722-9269
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
91752
CAPACITY:6CENSUS: 5DATE:
10/25/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Licensee William Choi and Licensee Patsara Chantharaseth TIME COMPLETED:
10:35 AM
ALLEGATION(S):
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9
Staff inappropriately touched resident in care.
Staff forced resident to be spoon fed.
INVESTIGATION FINDINGS:
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5
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Licensee William Choi and Licensee Patsara Chantharaseth and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record review.

LPA Rico conducted (4) staff interviews and (4) resident interviews.

For the allegation, Staff inappropriately touched resident in care.

During staff interviews, 4 out of the 4 staff stated they have not touched a resident inappropriately in care. 4 out of the 4 staff stated they have not witnessed a staff inappropriately touch a resident. During resident interviews 3 out of the 4 residents stated they have not been touched inappropriately. 1 out of the 4 resident was unable to corroborate on the above allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
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 56-AS-20240503162127
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: EARLY BIRD CARE HOME
FACILITY NUMBER: 335530128
VISIT DATE: 10/25/2024
NARRATIVE
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For the allegation, Staff forced resident to be spoon fed.

During staff interviews, 4 out of the 4 staff stated they have not forced a resident to be spoon fed. 4 out of the 4 staff stated that residents are independent with meals but will assist resident’s when needed. During resident interviews 3 out of the 4 residents stated they have not been forced to be spoon fed. 1 out of the 4 residents was unable to corroborate on the above allegation.

Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.


An exit interview was conducted, and this report (LIC9099) was discussed and provided to Licensee William Choi and Licensee Patsara Chantharaset.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2