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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604029
Report Date: 06/08/2021
Date Signed: 06/24/2021 09:49:11 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2021 and conducted by Evaluator Anna Kennedy
COMPLAINT CONTROL NUMBER: 08-AS-20210503082306
FACILITY NAME:HILLSIDE HAVEN GUEST HOMEFACILITY NUMBER:
374604029
ADMINISTRATOR:JARDIN, LEONAFACILITY TYPE:
740
ADDRESS:9141 SPICE STREETTELEPHONE:
(619) 741-3473
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:6CENSUS: 6DATE:
06/08/2021
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Leona JardinTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff consumed alcohol on facility premises during working hours.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Kennedy conducted an unannounced complaint visit to investigate the above allegation. LPA identified herself and met with Licensee and Administrator Leona Jardin, and discussed the purpose of today's visit.
During the investigation, LPA toured the facility, reviewed records and conducted interviews with internal and external sources.
The complaint allegation is that Individual 1 (I1) (See LIC 811 for a list of confidential names) consumed alcohol on facility premises during working hours. A review of records and interviews revealed that I1 was never employed at this facility.
Based on the above, the complaint allegation was determined to be Unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. We have therefore dismissed the complaint allegations.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE:

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

DATE:
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 08-AS-20210503082306
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HILLSIDE HAVEN GUEST HOME
FACILITY NUMBER: 374604029
VISIT DATE: 06/08/2021
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
This report was discussed with Leona Jardin. A copy along with Licensee Rights (01/2016) was emailed to Ms. Jardin at the conclusion of the visit and an electronic response confirms the receipt of these documents.
SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Anna Kennedy
LICENSING EVALUATOR SIGNATURE:

DATE: 06/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2