335530282-3-6-2026-56-AS-EMAN-DSCMQV-20260320094923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530282
Report Date: 03/06/2026
Date Signed: 03/06/2026 12:01:49 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
08/25/2025 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250825124455

FACILITY NAME:	MIRA LOMA SENIOR CARE HOME		FACILITY NUMBER:	335530282
ADMINISTRATOR:	PINERO, CAMILLE		FACILITY TYPE:	740
ADDRESS:	12400 DAKOTA RIVER CT		TELEPHONE:	(951) 444-6661
CITY:	EASTVALE	STATE: CA	ZIP CODE:	91752
CAPACITY:	10	CENSUS: 8	DATE:	03/06/2026
		UNANNOUNCED	TIME BEGAN:	08:34 AM
MET WITH:	Luz Hernandez		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff did not assist resident with hygiene as needed.
Facility staff did not assist resident with incontinence care as needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver the findings on the allegations listed above. LPA met with staff Luz Hernandez and explained the purpose of today’s visit. The investigation consisted of staff interviews, resident interviews and record review. The Licensee was also contacted and informed about today's visit.

For the allegation, Facility staff did not assist resident with hygiene as needed. During residents’ interviews, 3 out of the 3 residents stated staff assist with their hygiene and provide reminders when needed. During staff interviews, 3 out of the 3 staff stated hygiene is provided in the morning and night.

For the allegation, Facility staff did not assist resident with incontinence care as needed. During residents’ interview, 2 out of the 3 residents stated staff change their brief on time. Furthermore, 1 out of the 3 residents stated they are independent and do not require assistance to the bathroom. During resident interviews, 3 out of the 3 staff stated they change residents brief every two to three hours or as needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20250825124455

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: MIRA LOMA SENIOR CARE HOME	FACILITY NUMBER: 335530282
	VISIT DATE: 03/06/2026

NARRATIVE

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For the allegation, Facility staff did not assist resident with incontinence care as needed. During residents’ interview, 2 out of the 3 residents stated staff change their brief on time. Furthermore, 1 out of the 3 residents stated they are independent and do not require assistance to the bathroom. During resident interviews, 3 out of the 3 staff stated they change residents brief every two to three hours or as needed.

Based on the evidence found during the investigation, the two (2) allegations 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 staff Luz Hernandez.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 03/06/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2026

LIC9099 (FAS) - (06/04)

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