336423957-3-21-2025-56-AS-EMAN-DFXNKE-20250421103147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423957
Report Date: 03/21/2025
Date Signed: 03/21/2025 02:23:05 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/07/2022 and conducted by Evaluator Raquel Hernandez

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220907100959

FACILITY NAME:	ADORABLE HOME V		FACILITY NUMBER:	336423957
ADMINISTRATOR:	ROBERT C. CANTORIA		FACILITY TYPE:	740
ADDRESS:	7925 SADDLETREE COURT		TELEPHONE:	(951) 496-3238
CITY:	CORONA	STATE: CA	ZIP CODE:	92880
CAPACITY:	6	CENSUS: 4	DATE:	03/21/2025
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Staff James Smith		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff pushed resident while in care.
Staff handles resident in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Staff James Smith and explained the purpose of the visit. The investigation consisted of staff and resident interviews.

For the allegation, Staff pushed resident while in care.

LPA Hernandez conducted (2) resident interviews. 2 out of the 2 residents stated they have never been pushed by any of the facility staff or have witnessed other residents in care being pushed by facility staff. LPA Hernandez conducted (3) staff interviews. 3 out of the 3 staff stated they have not pushed any residents in care or witnessed any other staff doing so.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

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-20220907100959

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ADORABLE HOME V	FACILITY NUMBER: 336423957
	VISIT DATE: 03/21/2025

NARRATIVE

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For the allegation, Staff handles resident in a rough manner.

LPA Hernandez conducted (2) resident interviews. 2 out of the 2 residents stated facility staff has never handled them in a rough manner or have witnessed facility staff handle other residents in care in a rough manner. LPA Hernandez conducted (3) staff interviews. 3 out of the 3 staff stated they have not handled any of the residents in care in a rough manner or have witnessed any other facility staff doing so.

Based on the evidence gathered during today’s investigation, the 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 the evidence to prove that the alleged violation occurred.

During today’s visit, no deficiencies were cited pertaining to these allegations 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 James Smith.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2025

LIC9099 (FAS) - (06/04)

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