<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004296
Report Date: 05/13/2025
Date Signed: 05/13/2025 04:09:29 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2023 and conducted by Evaluator Fred Arias
COMPLAINT CONTROL NUMBER: 22-AS-20230410152922
FACILITY NAME:PIERCE ADULT RESIDENTAL CARE HOMEFACILITY NUMBER:
306004296
ADMINISTRATOR:ROMMEL MENDOZAFACILITY TYPE:
735
ADDRESS:3112 PIERCE AVENUETELEPHONE:
(714) 556-5102
CITY:COSTA MESASTATE: CAZIP CODE:
92626
CAPACITY:6CENSUS: 2DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Winnie GrecoTIME COMPLETED:
04:24 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is falsifying personnel records.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of continuing a complaint investigation into the above allegation. LPA was greeted and granted entry by Staff 1 (S1). LPA observed a total of two staff on duty providing care to two clients. At approximately 9:05am, S1 notified Administrator (AD) Winnie Greco of the visit. AD confirmed with S1 and arrived at the facility at approximately 9:45am. During the course of the investigation, LPA obtained and reviewed copies of eleven staff records and conducted interviews with AD and two staff members present. The following was determined:

It was alleged that the facility is falsifying personnel records. Upon review of eleven staff records, LPA contacted the Crisis Prevention Institute, Inc. (CPI) who is the issuing authority for instructor certificates. LPA observed that on the Nonviolent Crisis Intervention Certificate by CPI, six out of eleven staff were trained by Instructor 1 (I1) from a period ranging from October 2013 to September 2019. LPA confirmed with CPI I1 was not authorized to provide training services.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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 22-AS-20230410152922
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PIERCE ADULT RESIDENTAL CARE HOME
FACILITY NUMBER: 306004296
VISIT DATE: 05/13/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Due to the instructor certificate for I1 deemed invalid, it voids the 12 CPI training hours for Staff 2 (S2) received October 2013 and September 2019, Staff 3 (S3) received October 2018, Staff 4 (S4) received September 2019, Staff 5 (S5) received September 2019, Staff 6 (S6) received September 2019, and Staff 7 (S7) received September 2019.

LPA interviews with AD and staff revealed since 2024 when AD was assigned to the facility, CPI training is conducted by a verified CPI instructor (I2). LPA verified I2's certification status with CPI. LPA verified current CPI training is valid.

CPR training is done online utilizing National CPR Foundation as the service provider. LPA verified all current CPR certificates are valid.

Based on the observations, interviews, and the records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is deemed SUBSTANTIATED. A deficiency is being cited per Title 22, Division 6 of the California Code of Regulations. See LIC9099D.

An exit interview was conducted with Administrator Winnie Greco, and a copy of this report along with the LIC9099C, LIC811s, LIC9099D, and the appeal rights were provided during this visit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20230410152922
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PIERCE ADULT RESIDENTAL CARE HOME
FACILITY NUMBER: 306004296
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/14/2025
Section Cited
CCR
80063(a)
1
2
3
4
5
6
7
(a) The licensee, whether an individual or other entity, is accountable for the general supervision of the licensed facility, and for the establishment of policies concerning its operation...
1
2
3
4
5
6
7
Licensee to review and to forward an Acknowlegement of Understanding of the said regulation to LPA via email by POC due date.
8
9
10
11
12
13
14
This requirement is not met as evidenced by:

Based on observation, interviews, and record review, LPA reviewed false CPI training certificates not recognized by CPI which poses an immediate Health, Safety, and Personal Rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3