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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880544
Report Date: 05/18/2025
Date Signed: 05/18/2025 03:50:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
09/09/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240909145521
FACILITY NAME:ANGELA'S CARE HOMEFACILITY NUMBER:
331880544
ADMINISTRATOR:ANGELA ZHANGFACILITY TYPE:
740
ADDRESS:13247 SUNBIRD DRTELEPHONE:
(951) 653-0652
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:6CENSUS: 6DATE:
05/18/2025
UNANNOUNCEDTIME BEGAN:
08:02 AM
MET WITH:Ying Zi ZhangTIME COMPLETED:
02:29 PM
ALLEGATION(S):
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Staff do not ensure that residents' dietary needs are met.
Staff threatened resident.
Resident was not accorded privacy.
INVESTIGATION FINDINGS:
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On May 18, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit to gather information regarding the above allegations. LPA met with Ying Zi Zhang, Licensee and Administrator, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3) resident members #1 to #7 (R1-R7) and witness #1 (W1). List of documents reviewed/obtained Register of Faciltiy Residents LIC 9020, Personne Report (dated 05/09/25), (R1-R7)'s Physicians Report LIC 602 (dated 01/05/23, 01/20/23, 06/14/23, 09/01/24, 01/06/25, 02/20/25, 03/17/25, and 03/18/25), Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 3/17/23, and 03/18/23), and other records pertinent to this complaint.

(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2025
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 5
Control Number 18-AS-20240909145521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGELA'S CARE HOME
FACILITY NUMBER: 331880544
VISIT DATE: 05/18/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #2: Staff do not ensure that residents' dietary needs are met.

It is alleged that facility staff did not meet residents’ dietary needs. Reports indicate that staff do not provide snacks to Resident #1 (R1) and that the facility charges for food. Additionally, the food supply comes from food donation banks. No further details regarding this matter were provided.

On September 16, 2024, October 04, 2024, and May 17, 2025, between 09:30 AM and 04:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) resident members could not validate this allegation. (R1) refuted this claim and stated it is false. (R2-R6) reported receiving three meals and two snacks daily to cater to their dietary needs. (R2-R6) expressed that food is healthy and of high quality. (R2-R6) confirmed that they are not charged for meals or snacks. (R7) was interviewed but could not converse due to a health condition.



On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not corroborate this allegation. (S1-S3) residents are provided three meals and two snacks in between. The snacks and meals are prepared to cater to individual dietary needs and preferences. (S1-S3) reported that grocery inventory supplies are purchased from major grocery retail chains such as Costco, Superior Market, and WinCo. (S1-S3) clarified that residents are not charged for their meals or snacks, as this is part of the basic services.

The Department inspected the food supply and noted the presence of various items, including bread, dairy products, eggs, cereal, fruits, and vegetables. Ample nonperishable food supplies were available for at least one week, while perishable items were sufficient for a minimum of two days on the premises following Title 22 regulations.

The review of the Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 03/17/23, and 03/18/23) revealed the following on page 8, under the Basic Services subsection Food Services (a)(b): Three (3) nutritious meals are provided daily, and snacks are available between meals.

(Evaluation Report continues LIC 9099-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20240909145521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGELA'S CARE HOME
FACILITY NUMBER: 331880544
VISIT DATE: 05/18/2025
NARRATIVE
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Special diets, prescribed by a physician, are included as a free service at no charge. An examination of the licensee's bank statements showed a trend of grocery purchases, where inventory supplies were sourced from reputable grocery chains.

Based on the information, there is not enough evidence to support the claim mentioned above.

Allegation #3: Staff threatened resident.
It is alleged that staff threatened Resident #1 (R1). The report details that the staff threatened (R1) with the ability to move out of the facility during an open conversation within the facility. No further details regarding this matter were provided.

On September 16, 2024, October 4, 2024, and May 17, 2025, between 9:30 AM and 4:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Five (5) out of the seven (7) resident members could not support the allegation. (R2-R6) reported that they have not experienced any threats from staff members. The residents appreciated the staff, stating they are treated like family. (R1) mentioned in a conversation that the licensee was insinuating (R1) to find a new place to live and (R1) was worried about the possibility of an eviction. However, (R1) noted that the licensee had no history of evicting residents. (R7) was interviewed but could not converse due to a health condition.

On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members stated this claim is false. (S1-S3) expressed that residents are treated with utmost respect and dignity and no resident is threatened in writing, verbal, or physically. (S1) clarified in an open conversation overheard (R1) and (R1)’s negative statements about the facility, and (S1) made an inquiry about the situation. (S1) stated that (R1) had misunderstood the conversation and there was never an eviction, even implied or served to (R1). According to (S1), (R1) was not evicted and continued to reside at the facility until November 2024. At that point, (R1) needed a higher level of care and transitioned to a skilled nursing home.

On May 09, 2025, between 04:48 PM and 05:07 PM, the Department interviewed the witness member identified as Witness #1 (W1), the family representative for (R1). (W1) confirmed that (R1) was a former Angela's Care Home resident until November 2024 and was transitioned to a skilled nursing home.
(Evaluation Report continues LIC 9099-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20240909145521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGELA'S CARE HOME
FACILITY NUMBER: 331880544
VISIT DATE: 05/18/2025
NARRATIVE
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(W1) confirmed that (R1) was never threatened with an eviction. (W1) explained that (R1)'s health condition affected (R1)'s state of mind.

The Department reviewed (R1)’s Physician Report LIC 602A (dated 09/1/24), which revealed that (R1)’s mental status was diagnosed as confused or disoriented. A further review of staff training topics included Alzheimer’s Disease and related disorders, caring for patients with a change in mental status, activities of daily living (ADLs) and behaviors, challenging behaviors, and Basic Essentials.

During the May 16, 2025 visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, the California Residential Care Facilities for the Elderly Complaint Poster, and the California Long Term Ombudsman Poster. This helps residents know their rights and feel good about their living situation.

Based on the information, there is not enough evidence to support the claim mentioned above.

Allegation #4: Resident was not accorded privacy.
It is alleged that Resident #1 (R1) is not accorded privacy. According to reports, (R1) was not granted privacy during a telephone conversation by staff. No further details regarding this matter were provided.

On September 16, 2024, October 4, 2024, and May 17, 2025, between 9:30 AM and 4:30 PM, the Department interviewed resident members identified as Resident #1 through Resident #7 (R1-R7). Five (5) out of the seven (7) residents could not validate the allegation. (R2-R6) claimed the staff grants them privacy. (R2) mentioned that not all residents have personal cell phones and will use the house phone. The staff granted permission to go anywhere in the facility to conduct their calls and there are no privacy issues. (R1) mentioned having had a telephone conversation in an open space with other residents and staff who were present. (R1) conducted the phone call not in private, and the discussions with the party were overheard.

On September 16, 2024, and May 17, 2025, between 09:00 AM and 04:30 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members stated this claim is untrue. (S1-S3) expressed that residents are treated with utmost respect, provided their space and privacy. The residents can use their personal space when conducting personal phone calls.
(Evaluation Report continues LIC 9099-C)
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20240909145521
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGELA'S CARE HOME
FACILITY NUMBER: 331880544
VISIT DATE: 05/18/2025
NARRATIVE
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(S1-S2) claimed that one incident with (R1) occurred when (R1) chose to perform the call in an open environment where staff and residents gathered for activities. (R1) had the privilege of making the call privately in (R1)’s room, locking the door for complete privacy, or taking the call in the patio area.

On May 09, 2025, between 04:48 PM and 05:07 PM, the Department interviewed the witness member identified as Witness #1 (W1), the family representative for (R1). (W1) confirmed that (R1) was often not in the right mind. (W1) stated that she was pleased with the facility's services. (W1) praised the licensee's operations and stated she had no concerns for (R1)'s care at this facility.

The review of (R1-R7) 's Admissions Agreement (dated 01/05/23, 04/19/23, 02/16/23, 03/17/23, and 03/18/23) revealed the following on page 23, under the Resident/Personal Rights, is verified with an acknowledgment signature. A further review of staff training topics included Alzheimer's Disease and related disorders, caring for patients with a change in mental status, activities of daily living (ADLs) and behaviors, challenging behaviors, and Basic Essentials.

During the May 16, 2025 visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, the California Residential Care Facilities for the Elderly Complaint Poster, and the California Long Term Ombudsman Poster. This helps residents know their rights and feel good about their living situation.

The Department was unable to conduct a follow-up interview with Resident #1 (R1) because the resident passed away on May 4, 2025, while in care at Rancho Bellagio Post Acute. The Department attempted to contact Resident #3 (R6)'s family representative, but none of the calls were returned.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated.

Based on the information, there is not enough evidence to support the claim mentioned above.

An exit interview conducted with administrator Ying Zi Zhang and copies of the report provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5