336426708-10-8-2025-18-AS-RORN-DMFUD8-20251014152907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426708
Report Date: 10/08/2025
Date Signed: 10/08/2025 01:41:57 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
05/09/2022 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20220509164352

FACILITY NAME:	ABOUNDING LOVE HOME CARE		FACILITY NUMBER:	336426708
ADMINISTRATOR:	DELA CRUZ, DENNIS		FACILITY TYPE:	740
ADDRESS:	13213 NAPA VALLEY COURT		TELEPHONE:	(951) 961-1303
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 3	DATE:	10/08/2025
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Orlando Trajico		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident was left down on the floor for an extended period of time after falling.
Staff did not prevent self harming behavior.

INVESTIGATION FINDINGS:

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On October 8, 2025, at approximately 8:30 AM, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced follow-up visit regarding a complaint. During the visit, LPA Richard met with staff member Orlando Trajico. LPA explained the purpose of the visit. Later, LPA Richard was joined by the Administrator, Cheryl Dela Cruz.

The investigation included the following actions: The LPA conducted interviews with the Administrator (A1) and two staff members (S1 and S2), one resident( R2) Additionally, the LPA interviewed the Placement Agency, Innovage (PAI). The LPA obtained and reviewed the Resident Roster and the Staff Roster dated 07/01/25. The LPA attempted to obtain and review the resident records for Resident R1, specifically the Face Sheet, Admission Agreement, Physician’s Report, or LIC 602A. However, the LPA was unable to access the resident's records, as it had been over three years since the resident was discharged. According to Title 22 regulations, the facility is not required to keep records on file after a resident has been discharged for over three years.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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 18-AS-20220509164352

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: ABOUNDING LOVE HOME CARE	FACILITY NUMBER: 336426708
	VISIT DATE: 10/08/2025

NARRATIVE

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Allegation: Resident was left down on the floor for an extended period of time after falling.

The complaint alleged that a resident was hospitalized after being on the floor for more than 12 hours. On October 8, 2025, at approximately 9:00 AM, LPA Richard interviewed the Administrator (A1), who stated that the resident had been at the facility for just over three weeks. During the first three days of the resident's stay, R1 began exhibiting behaviors that were not previously disclosed during the pre-assessment. LPA Richard also interviewed two staff members, referred to as Staff #1 and Staff #2 (S1-S2), who reported that the resident would slide down from the bed to the floor and yell and scream. LPA interviewed one resident (R2) who stated that R2 likes living there, and the staff helps R2 when requesting assistance.

On May 7, 2022, the staff had to call 911 to take the resident to the hospital due to R1 shouting and screaming; this was the last time the resident was at the facility. On October 6, 2025, LPA Richard contacted the Reporting Party to gather more information about the complaint filed with the department; however, the Reporting Party was no longer working there, and no additional information was provided. On October 8, 2025, LPA Richard interviewed the social worker from the Placement Agency, Innovage (PAI), but was unable to obtain any information about the resident's whereabouts. On October 08, 2025, LPA was unable to interview resident #1 (R1) due to R1's whereabouts being unknown.

Based on the evidence gathered, interviews conducted, the preponderance of evidence standard has not been met. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED.

Allegation #2: Staff did not prevent self-harming behavior.

The complaint stated that resident R1 had a blanket wrapped around their neck and expressed a desire to harm themselves. On October 8, 2025, at approximately 9:00 AM, LPA Richard interviewed the Administrator (A1), who mentioned that R1 had been at the facility for just over three weeks.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20220509164352

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: ABOUNDING LOVE HOME CARE	FACILITY NUMBER: 336426708
	VISIT DATE: 10/08/2025

NARRATIVE

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During the first three days of R1's stay, R1 began exhibiting behaviors that had not been disclosed during the pre-assessment, including yelling, screaming, and expressing a desire to harm themselves and others. This behavior prompted the staff to call 911 on May 7, 2022. LPA Richard also interviewed two staff members (S1 and S2), who confirmed that R1 would frequently yell, shout, and scream, and the staff felt the necessity of calling 911 to take R1 to the hospital. This incident marked R1's last time R1 was at the facility. LPA interviewed one resident (R2) who stated that R2 likes living there, and the staff helps R2 when requesting assistance.

On October 6, 2025, LPA Richard contacted the Reporting Party to gather more information regarding the complaint filed with the department. However, the Reporting Party was no longer employed at the place where the phone number was provided, and they could not provide any new information. On October 8, 2025, LPA Richard interviewed the social worker from the Innovage placement agency, who was also unable to provide any information about R1's whereabouts. On October 08, 2025, LPA was unable to interview R1 due to R1's whereabouts being unknown.

No deficiencies cited.

An exit interview was conducted, and a copy of the Complaint Report was given to the staff, Orlando Trajico.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

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