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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800479
Report Date: 10/10/2024
Date Signed: 10/10/2024 11:02:38 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
06/13/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240613110631
FACILITY NAME:ASHER ESTATEFACILITY NUMBER:
361800479
ADMINISTRATOR:LEIPER, GRETCHENFACILITY TYPE:
740
ADDRESS:2487 EUCLID CRESCENT EASTTELEPHONE:
(909) 755-1157
CITY:UPLANDSTATE: CAZIP CODE:
91784
CAPACITY:6CENSUS: 4DATE:
10/10/2024
UNANNOUNCEDTIME BEGAN:
10:49 AM
MET WITH:Lakisha Shamburger-House ManagerTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Staff did not treat resident with dignity or respect.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility House Manager Lakisha Shamburger and explained the purpose of the visit. The investigation consisted of interviews and observation.

First allegation, Staff did not treat resident with dignity or respect. Regarding the first allegation “Staff did not treat resident with dignity or respect” LPA conducted interviews with staff and staff denied mistreating residents or violating residents’ rights. In addition, staff also denied witnessing staff not treating residents with dignity or respect. LPA conducted an interview with Resident #1 who stated that staff does use loud voice however, Resident#1 denied staff not treating resident[s] with dignity or respect. Resident#1 also denied witnessing staff not treating residents with dignity or respect.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2024
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-20240613110631
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: ASHER ESTATE
FACILITY NUMBER: 361800479
VISIT DATE: 10/10/2024
NARRATIVE
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Second allegation, Staff handled resident in a rough manner. Regarding the second allegation “Staff handled resident in a rough manner” LPA conducted interviews with staff regarding the above allegation and staff denied handling resident[s] in a rough manner in addition, staff also denied witnessing staff handle resident[s] in a rough manner. LPA conducted an interview with Resident #1 who denied staff handling resident[s] in a rough manner. Resident #1 also denied witnessing or hearing staff handling residents in a rough manner. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility House Manager Lakisha Shamburger at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

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

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