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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800198
Report Date: 11/01/2022
Date Signed: 09/12/2025 11:14:30 AM

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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2022 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221024143427
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: 5DATE:
11/01/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Glenn Bernal TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing residents medications as prescribed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation that staff are not providing residents medication as prescribe. LPA met with administrator Glenn Bernal and explained the elements of the complaint.

LPA Prieto interviewed resident #1 (R1), R2, R3 and R4. All stated that their medications are being dispensed as prescribed. LPA obtained the Medication Administration Record (MAR) log for R5. Records show that the medication is being dispensed as prescribed.

This agency has investigated the complaint alleging staff not providing residents medications as prescribed. . We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. This report was signed by LPA Prieto and Administrator Bernal and a copy was left with the facility.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
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
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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2022 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221024143427

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: 5DATE:
11/01/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Glenn Bernal, Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful eviction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPA Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation of an unlawful eviction. LPA met with administrator Glenn Bernal and explained the elements of the complaint.

LPA obtained a copy of the 30 day notice issued to resident #5 (R5). 30 day notice was signed by R5 and dated 10/22/22 as received by facility administrator. Interview with staff and other witnesses states that there was an agreement to transfer R5, in which, a 30 day notice was to be in compliance with Title 22 regulations. Notice is dated 10/22/22 and resident no longer resides at the facility.

Based on the information obtained there is not enough evidence that unlawful eviction. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Bernal and a copy was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 2