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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426141
Report Date: 10/30/2023
Date Signed: 10/30/2023 04:08:29 PM

Unfounded


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
10/04/2023 and conducted by Evaluator Amber Coleman
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231004142546
FACILITY NAME:HALCYON PLACE IFACILITY NUMBER:
366426141
ADMINISTRATOR:MARYA ALPERTFACILITY TYPE:
740
ADDRESS:6947 KIRKWOOD AVENUETELEPHONE:
(951) 818-6667
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 4DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Eva Tancinco, CaregiverTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Uncleared staff members are allowed to work in the facility.
Facility does not have a qualified Administrator.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Halycon Place I, Residential Care Facility for the Elderly unannounced to initiate a complaint investigation into the allegations listed above. LPA introduced self to staff and stated purpose of the visit. Eva Tancinco, Caregiver granted LPA entry inside the facility and contacted the Administrator, Mayra Alpert to inform her of LPA visit. LPA spoke with Administrator over the phone and disclosed the purpose of the visit.

It is alleged that uncleared staff members are allowed to work in the facility. LPA reviewed staff files of seven, (7) staff members employee files. 7 out of 7 employee files included fingerprint and criminal background checks. LPA researched and found that each staff member is also associated to the facility as required by regulation. Additionally, each staff file included up to date training as regulated.

It is alleged that the facility does not have a qualified Administrator. A review of staff files revealed that the

Please see LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
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 4
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
10/04/2023 and conducted by Evaluator Amber Coleman
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231004142546

FACILITY NAME:HALCYON PLACE IFACILITY NUMBER:
366426141
ADMINISTRATOR:MARYA ALPERTFACILITY TYPE:
740
ADDRESS:6947 KIRKWOOD AVENUETELEPHONE:
(951) 818-6667
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 4DATE:
10/30/2023
UNANNOUNCEDTIME BEGAN:
04:05 PM
MET WITH:Eva TancincoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff prevented home health agency staff from performing their duties.
INVESTIGATION FINDINGS:
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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Halcyon Place I, facility unannounced to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Eva Tancinco, Caregiver at the door. LPA introduced self and stated the purpose of the visit. LPA was granted entry. Caregiver contacted Administrator, Marya Alpert to make her aware of LPA visit. LPA spoke with Administrator over the phone and stated purpose of visit.

It is alleged that staff prevented home health agency staff from performing their duties. During staff interviews, LPA learned that there is an ongoing dispute between the residents in care, the home health agency and staff. Staff and the families of residents in care have communicated that they no longer wish to continue using the home health agency. The home health agency will not discharge the residents from the services. Because the home health agency will not discharge the residents from their service, it is posing issue with the residents signing up for services with an alternate home health agency.

Please see LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20231004142546
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: HALCYON PLACE I
FACILITY NUMBER: 366426141
VISIT DATE: 10/30/2023
NARRATIVE
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Based on the information above, these allegations are UNSUBSTANTIATED. A 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. No deficiencies cited at this time. An exit interview was conducted where this report (LIC9099 & LIC9099C) was discussed, and a copy of this report was provided to Facility Representatives at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20231004142546
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: HALCYON PLACE I
FACILITY NUMBER: 366426141
VISIT DATE: 10/30/2023
NARRATIVE
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facility has three active Administrators. Each Administrator Certificate was located inside their staff file and is reflected on the Community Care Licensing Administrator website as up to date and in good standing. There is no evidence to support that facility was at any time without a qualified Administrator.

Based on information above, we have found the complaint allegation(s) is/ are unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed with, and furnished to the facility representative.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amber Coleman
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4