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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880916
Report Date: 04/12/2024
Date Signed: 04/12/2024 11:51:20 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/05/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240405152536
FACILITY NAME:ADVENTURE CARE HOMEFACILITY NUMBER:
331880916
ADMINISTRATOR:CANTORIA, MARIAFACILITY TYPE:
740
ADDRESS:1992 TEMESCAL AVE.,TELEPHONE:
(909) 569-2280
CITY:NORCOSTATE: CAZIP CODE:
92860
CAPACITY:6CENSUS: 4DATE:
04/12/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Robert Cantoria , Administrator TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff not assisting client with dental hygiene needs
Facility staff not ensuring clients have sufficient intake of food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Administrator Robert Cantoria and explained the elements of the complaint.

Regarding the allegations that the facility staff not assisting client with dental hygiene needs; LPA Prieto interviewed resident #1 (R1) in question, who stated that they can handle their own dental hygiene needs and does so on a daily basis. R1's medical and assessment records indicate that R1 is able handle their own hygiene needs, including dental, with no assistance from staff. R1 has a dental service and LPA Prieto obtained those records to show that dental services are being provided. Facility administrator states they have collaborated other agencies to cover cost of R1's dental needs. ***continued on LIC 9099C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2024
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-20240405152536
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: ADVENTURE CARE HOME
FACILITY NUMBER: 331880916
VISIT DATE: 04/12/2024
NARRATIVE
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Regarding the allegation that the facility staff not ensuring clients have sufficient intake of food. LPA Prieto interviewed R1, who states that the facility staff does prepare food that R1 enjoys eating and looks forward to eating. LPA Prieto obtained a sample of the food being served to the residents for the last 3 days. Those meals consisted of a protein, greens, vegetables and protein drinks. Administrator ask staff to take pictures of food being served to assure residents are being prepared food that is nutritious and of good quality.

Based on the information obtained there is not enough evidence that facility staff not assisting client with dental hygiene needs and facility staff not ensuring clients have sufficient intake of food. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Cantoria and a copy was left with the facility
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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