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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800154
Report Date: 06/13/2026
Date Signed: 06/13/2026 06:30:42 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2024 and conducted by Evaluator Gabriela Castro
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240311133803
FACILITY NAME:CASA ALISAFACILITY NUMBER:
331800154
ADMINISTRATOR:ALCOCER, PETER KFACILITY TYPE:
735
ADDRESS:15849 ALISA VIEJO COURTTELEPHONE:
(714) 448-0533
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:4CENSUS: 4DATE:
06/13/2026
UNANNOUNCEDTIME BEGAN:
08:24 AM
MET WITH:Michael Larry, Caregiver & Peter Alcocer,Administrator TIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Uncleared individual provided care and supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced complaint visit on 06/13/2026 to deliver findings related to the above allegation. LPA was greeted by facility staff and Administrator Peter Alcocer was contacted via phone. LPA explained the purpose of the visit.

The investigation included a review of the client roster, staff roster, and Guardian records. Additionally, LPA conducted interviews with three staff members (S1–S3) and three clients (C1–C3).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
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-20240311133803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: CASA ALISA
FACILITY NUMBER: 331800154
VISIT DATE: 06/13/2026
NARRATIVE
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Allegation: Uncleared individual provided care and supervision

It is alleged that an unclear individual provided care and supervision to residents at the facility. It was reported the individual worked at the facility from approximately 12/18/2023 through 01/29/2024 without obtaining a criminal record clearance. During record review, LPA reviewed CDSS Guardian system and confirmed that a criminal record clearance application had been initiated by the facility on 12/16/2023; however, the application was not completed. Additionally, the Licensee acknowledged that the individual participated in training with licensee that included medication management and providing care and supervision to residents prior to obtaining a criminal record clearance. Licensee stated that this experience was "a lesson learned" and indicated that they would ensure proper clearance procedures are followed before allowing individuals to participate in training or resident care in the future. During former S1's interview, S1 stated that they worked at the facility from approximately 12/18/2023 through 01/29/2024. S1 reported that, during that time, they participated in training that included medication management and providing care and supervision to residents. During client interviews, C1 recalled the staff member but stated that they had not seen them recently. C2 and C3 stated that they did not know the staff member.

Based on LPA's observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D. Immediate Civil penalties are being issued during today’s visit in the amount of $500. Due to uncleared staff working at the facility. Please refer to LIC 421.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240311133803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: CASA ALISA
FACILITY NUMBER: 331800154
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/14/2026
Section Cited
CCR
80019(e)(2)
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(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:
(2) Obtain a California clearance or a criminal record exemption as required by the Department or
This requirement is not met as evidenced by:
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 Licensee shall read and understand the regulation cited . Licensee agrees to ensure that all staff members, volunteers, and individuals having contact with residents obtain a criminal record clearance prior to providing care and supervision to residents. Licensee shall submit a written statement to the Department confirming understanding of the regulation and outlining the steps that will be taken to ensure ongoing compliance.
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Based on record review the licensee did not comply with the section cited above by the Licensee allowing an individual to provide care and supervision to residents prior to obtaining a criminal record clearance which poses an immediate health, safety or personal rights risk to persons in care.
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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: David Sicairos
LICENSING EVALUATOR NAME: Gabriela Castro
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3