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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881510
Report Date: 10/27/2025
Date Signed: 10/27/2025 02:16:09 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
09/29/2025 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250929192313
FACILITY NAME:AMPM COMFORT CARE, INC.FACILITY NUMBER:
331881510
ADMINISTRATOR:AGUINALDO, RUSSELLFACILITY TYPE:
740
ADDRESS:30096 ALEXANDER DRIVETELEPHONE:
(818) 966-0088
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 4DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Russell Aguinaldo, AdministratorTIME COMPLETED:
02:40 PM
ALLEGATION(S):
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Staff left resident on floor for an extended period of time.
Staff left resident soiled for an extended period of time.
Staff did not provide resident with clean linen.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Russell Aguinaldo, Administrator. The Department’s investigation involved interviews with staff and residents and review of records.

It was alleged staff left resident on floor for an extended period of time. According to the information received, Resident #1 (R1) was reportedly found on the floor and soaked in urine. LPA’s record review revealed R1 was admitted in April 2022 with primary diagnosis of a cognitive condition. LPA interviewed R1, who stated they fell while attempting to get out of bed without requesting staff assistance. R1 reported that Staff #1 (S1) entered the room shortly after their fall and found them on the floor. R1 was unable to recall the exact duration they remained on the floor or whether they had been changed prior to their fall incident. R1 stated they were not on the floor for long periods when Staff #1 (S1) came into the room to check on them.

Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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 3
Control Number 18-AS-20250929192313
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: AMPM COMFORT CARE, INC.
FACILITY NUMBER: 331881510
VISIT DATE: 10/27/2025
NARRATIVE
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LPA conducted interviews with three (3) other residents and their relevant parties, all of whom stated the staff have provided good care for the residents, including regular checks throughout the day and night. LPA conducted an interview with S1 who stated they checked on R1 a few hours before they found R1 on the floor. LPA’s interview with the Administrator corroborated the statements of S1 and the residents. Based on the record review and interviews conducted, there is insufficient evidence to support the allegation that staff left resident on the floor for an extended period of time. The allegation is unsubstantiated.

It was alleged that staff left resident soiled for an extended period of time. According to the information received, R1 was found soaked in urine, and their bed had multiple absorbent pads with significant amount of urine. LPA’s file review revealed medical condition affecting R1’s appetite. LPA conducted an interview with R1, who stated staff have provided regular checks and incontinence care throughout the day. LPA conducted an interview with R1’s relevant party (RP), who stated that staff have provided regular checks and incontinence care. RP stated they have visited R1 every other day and have never noticed any issue with staff providing incontinence care. RP also acknowledged R1’s medical condition related to their appetite. LPA conducted interviews with three (3) other residents and their relevant parties, all of whom denied ever being left soiled or experiencing neglect in incontinence care. LPA conducted interviews with two (2) staff members, all of whom stated that all residents receive regular checks and incontinence care throughout the day. Both staff members emphasized that the facility operates as a small home setting, allowing staff to remain in close proximity to residents at all times. Based on the record review and interviews conducted, there is insufficient evidence to support the allegation that staff left resident soiled for an extended period of time. The allegation is unsubstantiated.

It was alleged that staff did not provide resident with clean linen. According to the information received, R1’s bed had multiple absorbent pads soaked with significant amount of urine. LPA’s file review revealed that R1 required incontinence care. LPA conducted an interview with R1, who stated that the absorbent pads on the bed are for extra protection in case of any leak from incontinence briefs. R1 stated staff have provided linen change whenever necessary or after bathing. LPA conducted an interview with R1’s relevant party (RP), who stated that staff have provided linen changes regularly. RP has visited R1 every other day and has never noticed soiled linen or bedding. LPA conducted interviews with three (3) other residents and their relevant parties, all of whom stated staff have provided linen change with every bath.

Continued on LIC9099-C....

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250929192313
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: AMPM COMFORT CARE, INC.
FACILITY NUMBER: 331881510
VISIT DATE: 10/27/2025
NARRATIVE
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LPA observed that R1 was the only resident who had absorbent pads on their bed. LPA’s interviews with two (2) staff members corroborated the statements from the residents and their relevant parties. Based on the record review and interviews conducted, there is insufficient evidence to support the allegation that staff did not provide resident with clean linen. The allegation is unsubstantiated.

A finding of Unsubstantiated means that the allegation may have occurred or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred.

LPA toured the interior and exterior areas of the facility and did not find any health and safety concerns.

An exit interview was conducted where a copy of this report was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3