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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413086
Report Date: 06/04/2025
Date Signed: 06/04/2025 09:53:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
05/04/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250504191752
FACILITY NAME:MC BOARD & CAREFACILITY NUMBER:
336413086
ADMINISTRATOR:MARIA AGUILARFACILITY TYPE:
740
ADDRESS:24259 BRILLANTE DRIVETELEPHONE:
(951) 813-2143
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:6CENSUS: 3DATE:
06/04/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Maria AguilarTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff are inappropriately locking in the residents while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unnannounced visit for the purpose to deliver findings on the allegation listed above. LPA met with Administrator Maria Aguilar and explained the purpose of the visit. The investigation consisted of staff interviews and resident interviews.

For the allegation, Staff are inappropriately locking in the residents while in care.

LPA Hernandez observed a steel rod installed into front door. Administrator stated steel rod was put into top of door due to former resident breaking the door lock. LPA advised steel rod is to be removed immediately.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
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 56-AS-20250504191752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MC BOARD & CARE
FACILITY NUMBER: 336413086
VISIT DATE: 06/04/2025
NARRATIVE
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Based on the evidence gathered during today’s investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met.

During today’s visit, one deficiency was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and (LIC9099D) was discussed and provided to Administrator Maria Aguilar along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250504191752
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MC BOARD & CARE
FACILITY NUMBER: 336413086
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/05/2025
Section Cited
CCR
87468.1(6)
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87468.1 Personal Rights of Residents in All Facilities: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night...
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Licensee stated to immediately remove steel rod and seal up hole by Plan of Correction (POC) due date and submit photo documentation to LPA Hernandez.
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Based on observations, the licensee did not comply with the section cited above by not ensuring residents were being locked appropriately while in care by installing a steel rod into door, which poses an immediate health, safety, and personal rights risks to those in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3