<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880822
Report Date: 07/11/2025
Date Signed: 07/11/2025 12:57:32 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
06/24/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240624141719
FACILITY NAME:KUN BAI CARE #2 HOMEFACILITY NUMBER:
331880822
ADMINISTRATOR:BRANDON MARQUEZ-GUTIERREZFACILITY TYPE:
740
ADDRESS:4091 ELDERBERRY RIDGETELEPHONE:
(909) 994-6199
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:6CENSUS: 4DATE:
07/11/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jair Melgarieio MartinezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff left resident unattended, covered in urine and blood, for extended periods.
Staff did not assist resident in a timely manner.
Due to a language barrier, staff can't communicate.
Inadequate food service.
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 deliver findings on the allegations listed above. LPA met with staff Jair Melgarieio Martinez and explained the purpose of the visit. The Administrator Brandon Marquez was also contacted and informed about today’s visit. The investigation consisted of staff interviews, resident interviews and record reviews.

For the allegation, Staff left resident unattended, covered in urine and blood, for extended periods. During resident interviews, 4 out of the 4 residents stated they have not been left unattended, covered in urine and blood, for an extended period. During staff interviews, 3 out of the 3 staff stated they have not left their residents unattended, covered in urine and blood for an extend period. LPA Rico conducted a facility tour and did not observe residents covered in urine or blood.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
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 2
Control Number 56-AS-20240624141719
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: KUN BAI CARE #2 HOME
FACILITY NUMBER: 331880822
VISIT DATE: 07/11/2025
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
For the allegation, Staff did not assist resident in a timely manner. During resident interviews 4 out of the 4 residents stated they receive assistance in a timely manner. During staff interviews, 3 out of the 3 staff stated they assist their residents in a timely manner.

For the allegation, due to a language barrier, staff can't communicate. During resident interviews 4 out of the 4 residents stated they can communicate with staff members. In addition, R3 and R4 confirmed they prefer to speak Spanish. During staff interviews 3 out of the 3 staff stated they can communicate with their residents.

For the allegation, Inadequate food service. During residents’ interviews, 4 out of the 4 residents stated they receive their meals and can request more food. During staff interviews, 2 out of the 2 staff stated they will ensure they have enough food supply. Furthermore, LPA observed the facility adequate food supply for the number of residents.

Based on the evidence found during the investigation, the four (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is 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 staff Jair Melgarieio Martinez.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2