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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881048
Report Date: 01/03/2025
Date Signed: 01/03/2025 11:40:41 AM

Unsubstantiated


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
12/13/2024 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20241213123255
FACILITY NAME:AQUA RIDGE OF MONTCLAIRFACILITY NUMBER:
361881048
ADMINISTRATOR:MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:9631 MONTE VISTA AVETELEPHONE:
(909) 483-2782
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:115CENSUS: 68DATE:
01/03/2025
UNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Monique Del Junco, Executive DirectorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff caused injury to resident in care
Staff did not ensure resident's room was kept clean
Staff falsified resident records
Staff consume alcohol while on shift
INVESTIGATION FINDINGS:
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On 1/03/2024 at 10:35 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA met with Executive Director Monique Del Junco and explained the purpose of the visit. The investigation consisted of file reviews, interviews with facility staffs and residents as well as observation.

Allegation: Staff caused injury to resident in care. Based on interviews conducted with 7 out of 7 residents and 7 out 7 staff all stated that they have not witness/observed or have knowledge of any staff causing injury to residents in care. Interviews with 3 out 7 residents stated that they are being taken care of and the staff are very kind and nice to them.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
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 2
Control Number 56-AS-20241213123255
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: AQUA RIDGE OF MONTCLAIR
FACILITY NUMBER: 361881048
VISIT DATE: 01/03/2025
NARRATIVE
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Allegation: Staff did not ensure resident's room was kept clean. Based on observation, record review, and interviews with facility staff and residents. All resident’s room are cleaned regularly as indicated in the staff cleaning schedule.

Allegation: Staff falsified resident records. Based on interviews conducted with 7 out 7 residents and 7 out of 7 staff they all stated that they have not witness or have knowledge of any staff falsifying documents and there is no evidence to corroborate the allegation. One resident stated that the facility is very honest, and the facility let the residents know of what is going on.

Allegation: Staff consume alcohol while on shift. Based on interviews conducted with 7 out 7 residents and 7 out of 7 staff all stated that they have not witness/observed or have knowledge of any staff drinking alcohol while on shift.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Executive Director Monique Del Junco.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 01/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2025
LIC9099 (FAS) - (06/04)
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