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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426762
Report Date: 11/12/2021
Date Signed: 11/12/2021 02:20:32 PM

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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/03/2020 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200403105125
FACILITY NAME:HIGHLAND SENIOR HOME CARE LLCFACILITY NUMBER:
366426762
ADMINISTRATOR:LIWANAG, AMPAROFACILITY TYPE:
740
ADDRESS:7513 SWEETMEADOW COURTTELEPHONE:
(909) 714-0225
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:6CENSUS: 4DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Amparo Liwanag, AdministratorTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff hit resident
Staff have not undergone a criminal record clearance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA was greeted by staff, Patricia Salinas, and later met with Administrator, Amparo Liwanag. Liwanag was informed of the purpose of the visit.

Pertaining to the allegation, "Staff hit resident," it was alleged a resident in care was physically abused by Staff One (S1) in November or December 2019. The investigation was initiated on April 09, 2020. Administrator Liwanag was interviewed and denied having any knowledge of the allegation. Staff/resident interviews were conducted, and no reports of abuse were disclosed. Interviews could not reveal the name of the resident involved in the allegedly incident. S1 could not be reached for an interview. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation, "Staff have not undergone a criminal record clearance," it was alleged S1 and Staff Two (S2) were working at the facility and providing care and supervision to residents without an appropriate
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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 18-AS-20200403105125
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
RIVERSIDE, CA 92507
FACILITY NAME: HIGHLAND SENIOR HOME CARE LLC
FACILITY NUMBER: 366426762
VISIT DATE: 11/12/2021
NARRATIVE
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criminal record clearance. Administrator Liwanag was interviewed and denied the allegation. S1 could not be reached for an interview. Department Licensing Information System records show S1 did not possess an approved criminal background clearance. Staff/resident interviews did not disclose information on whether S1 was or was not working at the facility at/or around the time the allegation was made. S2 was interviewed and denied working at the facility without a criminal record clearance. Department Licensing Information System records show S2 has been cleared since September 25, 2017. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was reviewed with Liwanag and a copy provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2