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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800198
Report Date: 10/17/2022
Date Signed: 10/17/2022 12:13:59 PM

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
10/11/2022 and conducted by Evaluator Natalie Ibarra
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221011091558
FACILITY NAME:MGB CARMEL MANORFACILITY NUMBER:
361800198
ADMINISTRATOR:BERNAL, GLENNFACILITY TYPE:
740
ADDRESS:457 WEST 13TH STREETTELEPHONE:
(909) 982-4786
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:6CENSUS: 6DATE:
10/17/2022
UNANNOUNCEDTIME BEGAN:
10:09 AM
MET WITH:Eladia PlenosTIME COMPLETED:
12:23 PM
ALLEGATION(S):
1
2
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9
Staff handle resident in a rough manor
Staff made inappropriate comments to resident
Resident was not accorded comfortable living accomodations
INVESTIGATION FINDINGS:
1
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5
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7
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9
10
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13
Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerreo made an unannounced visit to the facility to investigate the above allegations. LPAs met with caregiver Eladia Plenos. Administrator Glenn Bernal was notified of visit. The investigation consisted of interviews with pertinent parties.

The first allegation indicates staff handle resident in a rough manner. Interview with Resident #1 (R1) stated staff have never pushed, shoved, nor handled them in a rough manner. Interviews with Staff #1 (S1) and Staff #2 (S2) stated they have never witness staff handle R1 in a rough manner,

The second allegation indicates staff made inappropriate comments to resident. Interview with R1 stated staff have never made any rude or inappropriate comments to them. S1 and S2 stated they have never witness staff make any inappropriate comments to R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
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 2
Control Number 56-AS-20221011091558
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: MGB CARMEL MANOR
FACILITY NUMBER: 361800198
VISIT DATE: 10/17/2022
NARRATIVE
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The third allegation states resident was not accorded comfortable living accommodations. Interview with R1 stated that staff do accommodate to R1's needs and do provide a comfortable living environment. Staff will closed windows and have provided R1 with a heater and additional blankets due to being cold all the time. Interview S1 and S2 stated a fan has never been placed on R1. S1 indicated the only fan that staff will turn on is a hallway ventilation ceiling fan to air out any odors when changing residents in care.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to caregiver Eladia Plenos
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2