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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880570
Report Date: 12/21/2021
Date Signed: 12/21/2021 12:08:04 PM

Unsubstantiated


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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200325093433
FACILITY NAME:ALTA LOMA GARDENS RESIDENTIAL CARE #1FACILITY NUMBER:
361880570
ADMINISTRATOR:STARK PLEITEZ, ANAFACILITY TYPE:
740
ADDRESS:6896 HELLMAN AVETELEPHONE:
(818) 922-5427
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 4DATE:
12/21/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:"Margarita" Ana Stark - Licensee/AdministratorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failing to meet residents care needs
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of following up on an open complaint with the above allegation(s). LPA Colvin met with Licensee/Administrator "Margarita" Ana Stark and advised them of the purpose of today's visit. Below is a summary of the findings of the complaint.
Regarding allegation "Staff failing to meet residents care needs": LPA Colvin conducted interviews with current residents at the facility, as well as family members and responsible parties of residents who lived at the facility during the time of the complaint, but are no longer present. LPA Colvin's interviews did not result in any concerns regarding staff not meeting residents' needs. Additionally, LPA Colvin did not observe any visible concerns with the residents during today's inspection. Therefore, due to interviews and observations, the allegation "Staff failing to meet residents care needs" is UNSUBSTANTIATED. finding of UNSUBSTANTIATED means 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 with Licensee/Administrator "Margarita" Ana Stark and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
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