197608221-8-19-2025-28-AS-LHIS-DKRTTZ-20250821150132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608221
Report Date: 08/19/2025
Date Signed: 08/19/2025 10:50:50 AM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2025 and conducted by Evaluator Alberto Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250812143657

FACILITY NAME:	CHLOIE'S COTTAGE II		FACILITY NUMBER:	197608221
ADMINISTRATOR:	LINDA RENARD		FACILITY TYPE:	740
ADDRESS:	305 E. BASELINE ROAD		TELEPHONE:	(909) 592-4488
CITY:	SAN DIMAS	STATE: CA	ZIP CODE:	91773
CAPACITY:	6	CENSUS: 5	DATE:	08/19/2025
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Eva Tancinco, House Manager		TIME COMPLETED:	10:53 AM

ALLEGATION(S):

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9

Personal Rights
Personal Rights
Personal Rights
Personal Rights
Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Manager (LPA), Alberto Lopez made an unannounced visit to investigate the above allegations. LPA met with House Manager Eva Tancinco and discussed the purpose of the visit.

The investigation consisted of LPA obtaining and reviewing staff and resident rosters. LPA interviewed two (2) staff (S#1-S#2) LPA noticed that R1 was not on roster and S1 stated that R1 lives at Chloie's Cottage and not this facility. LPA took a tour of the facility and did not observe any health or safety risks.

The investigation revealed that the allegation could not have happened at this home as R1 does not reside at this home and has not lived at this address at least since S1 has worked at this address since 01/2025. LPA identified all 5 residents at home and R1 was not at living/present at facility during the visit.
The above allegations are UNFOUNDED. A finding of UNFOUNDED means that the allegation is either false, could not have happened, and/or is without a reasonable basis. Therefore, we have dismissed the complaint. Exit interview conducted with House Manger Eva Tancinco and a copy of this report was provided.

Unfounded

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Lisa Hicks
NAME OF LICENSING PROGRAM ANALYST: Alberto Lopez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/19/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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