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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530211
Report Date: 12/10/2024
Date Signed: 12/10/2024 01:01:31 PM

Unfounded


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
12/10/2024 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20241210090930
FACILITY NAME:BLESSED GARDEN HOME CORP.FACILITY NUMBER:
365530211
ADMINISTRATOR:RAMOS, LARIZA HOLCOMBFACILITY TYPE:
740
ADDRESS:935 BROOKSIDE AVENUETELEPHONE:
(909) 328-1828
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:6CENSUS: 1DATE:
12/10/2024
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Alvin Ramos LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
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8
9
Staff did not properly handle a deceased resident while in care.
INVESTIGATION FINDINGS:
1
2
3
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5
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9
10
11
12
13
Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to conduct a complaint investigation and deliver the findings. LPA Allen introduced herself and explained the purpose of the visit and the allegation to Alvin Ramos, the Licensee.

The investigation consisted of interviews with staff members, file review, and observations.

LPA interviewed staff members who reported that Resident 1 (R1) had passed away at the facility over the weekend. LPA reviewed documents indicating that the licensee complied with Community Care Licensing Division reporting requirements according to regulations. The files reviewed also showed that the deceased resident was appropriately handled while in care. LPA reviewed additional documents confirming the transportation company used to transport R1 from the facility. During the tour of the facility, LPA found no health and safety concerns.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
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-20241210090930
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: BLESSED GARDEN HOME CORP.
FACILITY NUMBER: 365530211
VISIT DATE: 12/10/2024
NARRATIVE
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Based on interviews and evidence gathered during the investigation, the above allegation is found to be Unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted where this report was discussed and provided to Alvin Ramos- Licensee at the conclusion of the visit with appeal rights.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2