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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880552
Report Date: 12/17/2024
Date Signed: 12/17/2024 05:33:00 PM

Unsubstantiated


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
11/26/2024 and conducted by Evaluator Mary Rico
COMPLAINT CONTROL NUMBER: 56-AS-20241126133334
FACILITY NAME:CURA AMOREFACILITY NUMBER:
331880552
ADMINISTRATOR:VITO, ANNA BELLAFACILITY TYPE:
740
ADDRESS:2394 MONTEREY PENINSULA DRTELEPHONE:
(626) 423-9194
CITY:CORONASTATE: CAZIP CODE:
92882
CAPACITY:6CENSUS: 6DATE:
12/17/2024
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:caregiver- Renz AcostaTIME COMPLETED:
05:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained unexplained injury while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with caregiver Renz Acosta to explain the purpose of the visit, and the Administrator Wendy Uson was contacted and informed. The investigation consisted of staff interviews, resident interviews, and record review. LPA Rico conducted (5) staff interviews and (6) resident interviews.

For the allegation, Resident sustained unexplained injury while in care.

During staff interviews, 5 out of the 5 staff stated that R1 was having a behavior and had accidentally hit themselves. In addition, 4 out of the 5 staff stated they took the proper protocols for resident safety and reported the incident report to management. Furthermore, 5 out of the 5 staff stated they have not hit their residents and have not witness another staff abuse their residents.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 56-AS-20241126133334
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: CURA AMORE
FACILITY NUMBER: 331880552
VISIT DATE: 12/17/2024
NARRATIVE
1
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3
4
5
6
7
8
9
10
11
12
13
14
15
16
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18
19
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21
22
23
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25
26
27
28
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31
32
During resident interviews, 4 out of the 6 residents stated they have not sustained an injury while in care. In addition, 4 out of the 6 residents stated they have not been abused by staff. Furthermore, 2 out of the 6 residents were unable collaborate to allegation listed above.

During record review, LPA observed a Special Incident Report was submitted to Community Care Licensing regarding R1 incident. The incident report indicated R1 was having a behavior while in care that caused for a self-injury.

Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.


An exit interview was conducted, and this report (LIC9099) was discussed and provided to caregiver Renz Acosta

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2