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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880884
Report Date: 03/07/2023
Date Signed: 03/07/2023 10:38:09 AM

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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220111141023
FACILITY NAME:AB'S HUMBLE HOME #2FACILITY NUMBER:
361880884
ADMINISTRATOR:HAMED, EBRAHEEMFACILITY TYPE:
740
ADDRESS:14798 CAMBRIA STTELEPHONE:
(909) 365-4265
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:6CENSUS: 6DATE:
03/07/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Sabrina SaenzTIME COMPLETED:
10:39 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff physically assaulted client.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced subsequent visit to continue the complaint investigation of and deliver findings on the above allegation. LPA met with care provider Lanny Latta who was informed of the reason for the visit. Administrator Ebraheem Hamed was phoned and administrative staff Sabrina Saenz arrived shortly. LPA conducted resident and staff interviews and reviewed records.

The allegation is Staff physically assaulted client (C1). All resident and staff interviews revealed that they do not know C1 or have heard of C1. Resident interviews deny that staff hit or physically assault them. Interviews with staff revealed that they don't hit any of the residents and that there has been no report of physical assault by any staff on any resident. LPA reviewed records confirming that staff have completed elder abuse training.

This allegation is therefore 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 with Sabrina Saenz and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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