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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336405884
Report Date: 11/05/2024
Date Signed: 11/05/2024 04:07:34 PM

Document Has Been Signed on 11/05/2024 04:07 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:INTEGRATED CARE COMMUNITIES - A1FACILITY NUMBER:
336405884
ADMINISTRATOR/
DIRECTOR:
EMELY C. RODRIGUEZFACILITY TYPE:
740
ADDRESS:14265 NASON STREETTELEPHONE:
(951) 601-9100
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY: 22CENSUS: 19DATE:
11/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:05 PM
MET WITH:Amanda Redell, Facility ManagerTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to follow up on an incident reported by the facility regarding an alleged sexual assault involving a resident in care. The LPA met with Facility Manager, Amanda Redell, and informed her of the purpose for the visit.

The Unusual Incident Report (UIR), received on 10/21/2024, revealed that on 10/20/2024 Resident One (R1) called 911 and reported a staff member touched a private area of their body on two separate occasions.

The LPA's investigation included staff, resident and third party interviews, records review, and records collection. One third party interview revealed the suspected individual was Staff One (S1). The third party and staff interviews revealed no one works for the facility by S1's name. R1 was interviewed and reported the incidences did take place several months ago. R1 provided a name of the alleged suspect, identified as Staff Two (S2). S2 was interviewed and denied the allegation. Three (3) resident interviews revealed no knowledge of any inappropriate behavior between staff and residents.

Additional time is required, prior to the conclusion of the investigation, in order to obtain further information. This report was reviewed and a copy was provided.

(NOTE: Administrator, Emely Rodriguez, was not available for the LPA's visit).
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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