<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880543
Report Date: 12/11/2025
Date Signed: 12/11/2025 10:23:13 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
11/18/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251118093502
FACILITY NAME:GREEN MERRYLANDSFACILITY NUMBER:
361880543
ADMINISTRATOR:BRANDON MARQUEZ-GUTIERREZFACILITY TYPE:
740
ADDRESS:15986 BALTRAY WAYTELEPHONE:
(909) 371-3402
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 3DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Facility administrator /Staff Brandon Marquez TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not maintain the facility free of odors.
Staff do not maintain facility floors free from slipping hazards.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/11/2025 at 8:45 AM, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on a complaint alleging neglect/lack of supervision. LPA Singh met with Facility Administrator/Staff Brandon Marquez, facility representative, and was granted entry into the facility. The investigation conducted by LPA Singh consisted of interviews and review of pertinent records.


Regarding the First Allegation: - Staff do not maintain the facility free of odors.

Interviews with RP, Staff, resident and LPAs observation determined that Licensee/Staff do not maintain the facility free of odors. LPA Singh smelled the stench in the facility and from rooms when entered the facility on 11/20/2025 and 12/11/2025. Therefore, the allegation that Licensee/Staff do not maintain the facility free of odors has been Substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 5
Control Number 56-AS-20251118093502
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: GREEN MERRYLANDS
FACILITY NUMBER: 361880543
VISIT DATE: 12/11/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Third Allegation: - Staff do not maintain facility floors free from slipping hazards.

The Licensed Program Analyst (LPA) Singh conducted interviews with the Responsible Person (RP), staff, a resident, and observed the facility, determining that staff did not maintain facility free from slipping hazards.


LPA Singh specifically observed a trail of damp, streaky marks on the floor, which were presumed to have been left by a wet wipe/mop immediately before the LPA entered the facility. These marks extended from the bathroom, across the hallway, and into a bedroom. Further evidence of this hazard was noted by the presence of wet wipe marks on the bathroom floor during the facility tour. Therefore, the allegation that Licensee/Staff do not maintain facility floors free from slipping hazards has been Substantiated.

Based on Investigation observations, interviews which were conducted and records review, the preponderance of evidence standard has not been met. Therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division & Chapter number) are being cited on the attached LIC 9099D). A civil penalty for a violation has been assessed in the amount of $2,200 in total.

An exit interview was conducted, and this report (LIC809) LIC 809C, LIC809D, LIC 421BG(7/17) and Appeal Rights were discussed and copies were provided to Facility administrator /Staff Brandon Marquez.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
11/18/2025 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251118093502

FACILITY NAME:GREEN MERRYLANDSFACILITY NUMBER:
361880543
ADMINISTRATOR:BRANDON MARQUEZ-GUTIERREZFACILITY TYPE:
740
ADDRESS:15986 BALTRAY WAYTELEPHONE:
(909) 371-3402
CITY:FONTANASTATE: CAZIP CODE:
92336
CAPACITY:6CENSUS: 3DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Facility administrator /Staff Brandon Marquez TIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not maintain the facility kitchen clean.
.
Staff do not ensure resident's incontinence care needs are met.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/11/2025 at 8:45 AM, Licensing Program Analyst (LPA) Beena Singh conducted an unannounced visit to the facility to deliver findings on a complaint alleging neglect/lack of supervision. LPA Singh met with Facility administrator /Staff Brandon Marquez , facility representative, and was granted entry into the facility. The investigation conducted by LPA Singh consisted of interviews and review of pertinent records.


Regarding the Second Allegation: - Staff do not maintain the facility kitchen clean.
Interviews with RP, Staff, resident and LPAs observation determined that Staff maintain the facility kitchen clean. LPA Singh observed kitchen area was clean, without any clutter on the worktop. Therefore, the allegation that Staff do not maintain the facility kitchen clean has been Unsubstantiated.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20251118093502
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: GREEN MERRYLANDS
FACILITY NUMBER: 361880543
VISIT DATE: 12/11/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Fourth Allegation: - Staff do not ensure resident's incontinence care needs are met.

Interviews with RP, Staff, resident and LPAs observation determined that Staff do not ensure resident's incontinence care needs are met. During the interviews with resident, resident stated their Staff ensures resident's incontinence care needs are met Therefore, the allegation that Staff do not ensure resident's incontinence care needs are met has been Unsubstantiated.


In conclusion, based on all the evidence obtained during the investigation, it was determined that Staff do not maintain the facility free of odors. Interviews with RP, Staff, resident and LPAs observation determined that Staff do ensure resident's incontinence care needs are met. Therefore, the allegation that Staff do not maintain the facility kitchen clean and staff do not ensure resident's incontinence care needs are not met are Unsubstantiated.


Based on the evidence found during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.


An exit interview was conducted, and this report (LIC809) LIC 809C were discussed and provided to Facility Administrator/Staff Brandon Marquez.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20251118093502
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: GREEN MERRYLANDS
FACILITY NUMBER: 361880543
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2025
Section Cited
CCR
87303(a)(1)
1
2
3
4
5
6
7
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.(1) Floor surfaces in bath, laundry and kitchen and facility areas shall be maintained in a clean, sanitary, and odorless condition.
1
2
3
4
5
6
7
Licensee will ensure facility is clean,sanitary and in odorless condition for residents in care by deep cleaning/sanitizing the facility done by POC due date and evidence to be sent to LPA Singh via email by the Plan of Correction(POC) due date 12/12/2025.
8
9
10
11
12
13
14
Based on observation, interview, record review, the licensee did not comply with the section cited above by not ensuring that floor surfaces in bath, and facility areas shall be maintained in a clean, sanitary, and odorless condition. which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5