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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880884
Report Date: 06/05/2023
Date Signed: 06/05/2023 01:51:01 PM

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
05/25/2023 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230525110115
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: 5DATE:
06/05/2023
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Sabrina SaenzTIME COMPLETED:
02:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is drinking alcohol at the faciltiy
Staff is intoxicated while working at the faciltiy
Staff has resident buy alcohol for staff
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Assistant Administrator Sabrina Saenz and explained the purpose of the visit. The investigation consisted of staff and resident’s interviews.

First allegation: Staff is drinking alcohol at the facility.

Regarding the first allegation, Staff is drinking alcohol at the facility. LPA Guerrero conducted in-person interviews with Resident #1, Resident #2, and Resident #3, who all stated that they have not witnessed Staff #1 drink alcohol while providing care. LPA interviewed Staff #1, who stated that they work at the facility Mon-Fri and arrive at the facility at random hours and has not witnessed Staff #1 consume alcohol while providing care.

Second allegation: Staff is intoxicated while working at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
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-20230525110115
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: AB'S HUMBLE HOME #2
FACILITY NUMBER: 361880884
VISIT DATE: 06/05/2023
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
Regarding the second allegation, Staff is intoxicated while working at the facility. LPA Guerrero conducted in-person interviews with Resident #1, Resident #2, and Resident #3, who all stated that they have not witnessed Staff #1 intoxicated at the facility while providing care. LPA interviewed Staff #1, who stated that they work at the facility Mon-Fri and arrive at the facility at random hours and has not witnessed Staff #1 intoxicated while providing care.

Third allegation: Staff has resident buy alcohol for staff.




Regarding third allegation, Staff has resident buy alcohol for staff. LPA Guerrero conducted in-person interviews with Resident #1, Resident #2, and Resident #3, who all stated that they have not witnessed residents purchase alcohol for Staff #1. In addition, Resident #1, Resident #2, Resident #3, stated that they have not purchased alcohol for staff, nor has staff asked Residents #1-3 to buy alcohol. Due to a lack of information, the above allegations are deemed UNSUBSTANTIATED at this time.

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

An exit interview was conducted where this report was discussed and provided to Facility Assistant Administrator Sabrina Saenz.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2