331880492-2-9-2026-18-AS-RORN-DR8LVN-20260212080545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880492
Report Date: 02/09/2026
Date Signed: 02/09/2026 01:56:55 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
12/16/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20241216165405

FACILITY NAME:	COMMUNITY CROSSINGS INC SAN JACINTO		FACILITY NUMBER:	331880492
ADMINISTRATOR:	ANDRADE, AUDREY		FACILITY TYPE:	775
ADDRESS:	641 N. STATE STREET #1		TELEPHONE:	(951) 654-3052
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY:	60	CENSUS: 47	DATE:	02/09/2026
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Xitlaly Gonzalez – Director Assistant		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not secure client in wheelchair leading to injuries during transport.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with Assistant Director Xitlaly Gonzalez and explained the purpose for todays visit.

The investigation consisted of the following:

LPA obtained copies of Staff/Client rosters, Copies of the following documents within C1’s file: Consumer Assessment, Physicians Report, Inland Regional Center IPP Meeting Summary. LPA interviewed 4 Staff (S1-S4), 5 Clients (C2-C6), and 1 Witness (W1) due to C1’s intellectual disability LPA was not able to Interview client, however, LPA was able to visibly see client and make observations during visit.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

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 18-AS-20241216165405

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: COMMUNITY CROSSINGS INC SAN JACINTO	FACILITY NUMBER: 331880492
	VISIT DATE: 02/09/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Staff did not secure client in wheelchair leading to injuries during transport.
It is alleged that on 12/13/24 C1 sustained injuries while getting out of a transportation van that was operated by the day program staff and had bruising towards the area of her coccyx and elbow. LPA interviewed 4 Staff and each denied the allegation, interview with S3 revealed that while transporting C1 to their residence, once bus was put in part client unbuckled themselves from seat and threw themselves on the floor of the bust and hit their bottom, S3 stated that C1’s caregiver from residence was present at the time and witnessed the incident and after this incident there was special accommodations made to C1’s transportation where C1 is to use wheelchair during transport at all times. Interview with S4 revealed that C1 does have behaviors of pushing self-back and wanting to sit on the floor, S3 stated that even when assisting C1 into the transportation van C1 will push themselves back and try to take off their seat belt, therefore, two seat belts are always put on C1 for safety and C1 is always in wheelchair during transport. LPA interviewed staff from residence (W1) and staff confirmed incident, and stated that C1 does have a behavior of throwing themselves on the floor and did not observe any neglect from staff during this incident, staff confirmed regional center conducted investigation, this was unsubstantiated, and a plan was added to C1’s transportation where C1 is to be transported in wheelchair at all times to avoid C1 from injuring themself again. LPA interviewed 5 Clients, and each denied the allegation and stated they have not been injured during transportation/drop-off, 3 of the 5 clients interviewed use wheelchairs and each said that they are assisted into the bus and are assisted with seat belts and have never had any accidents or incidents during transportation from facility. LPA reviewed C1’s file and did not observe any note prior to incident that stated client must use wheelchair during transport. Due to C1’s self-injurious behaviors and no evidence of neglect or lack of supervision by staff pertaining to this incident, this allegation will be unsubstantiated.

Based on statements and interviews conducted with staff, clients, and witness, review of C1’s files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

LIC9099 (FAS) - (06/04)

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