331880633-8-29-2025-18-AS-JDHS-DLFSM2-20250912135910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880633
Report Date: 08/29/2025
Date Signed: 08/29/2025 11:31:53 AM

Unfounded

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
07/17/2025 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20250717143749

FACILITY NAME:	CALIFORNIA MANOR GUEST HOME #1		FACILITY NUMBER:	331880633
ADMINISTRATOR:	HAMED, NAJEH		FACILITY TYPE:	740
ADDRESS:	8536 & 8548 CALIFORNIA AVE		TELEPHONE:	(786) 219-6008
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	12	CENSUS: 12	DATE:	08/29/2025
		UNANNOUNCED	TIME BEGAN:	10:56 AM
MET WITH:	Caregiver Fermin Cornista		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Staff is locking the refrigirator at night time.
Staff does not allow residents to keep their pets.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA Perez met with Caregiver, Fermin Cornista, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff and witnesses, observations, and file reviews.

On July 17, 2025, Community Care Licensing received a complaint alleging facility staff is locking the refrigerator at night and staff do not allow residents to keep their pets. Throughout the investigation, LPA interviewed staff and residents and obtained supportive documentation to aid in determining the findings of the noted allegations. Multiple interview attempts were made with Additional Witness 1 (AW1) to gather further information, however, AW1 did not respond to the interview request.

Continued on LIC 9099-C.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025

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 18-AS-20250717143749

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: CALIFORNIA MANOR GUEST HOME #1	FACILITY NUMBER: 331880633
	VISIT DATE: 08/29/2025

NARRATIVE

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Regarding the allegation that facility staff lock refrigerators at night, it was alleged that residents were prevented from accessing or storing their personal food items due to staff locking the refrigerator at night. Interview with Administrator Najeh Hamed, confirmed that the facility maintains four refrigerators on site, in which three are designated for facility provided food and for resident use. Administrator added that one refrigerator located at the back of the garage is reserved exclusively for staff use. Administrator clarified that the staff refrigerator remains locked to secure employee food items and the refrigerator does not contain any allocated food for the residents.

Interviews conducted with five out of five residents corroborated that the three resident refrigerators are accessible at all times and have not been seen locked, including at night. Residents also confirmed their awareness that the locked refrigerator in the garage is designated for staff use only. Residents did not have any concerns with refrigerators being locked or storing their items in the allocated resident refrigerators. Additional interviews with multiple staff members further supported that refrigerators intended for residents are never locked and remain accessible to those in care. LPA Perez documented observations made and verified that three refrigerators were designated for resident use, while a separate and secured refrigerator located at the back of the garage, was reserved for staff.

Regarding the allegation that staff do not allow residents to keep their pets, it was alleged that residents are not allowed to keep their pets despite the fact they moved into the facility with their pets. Interview with Administrator stated that a temporary exception was made for Resident 1 (R1) due to an urgent housing need. Administrator explained R1’s previous housing arrangement had ended and to prevent homelessness, Administrator permitted R1 to bring their pet into the facility under the condition that it would be relocated shortly after admission. Administrator confirmed that R1 requested the accommodation due to an urgent need. Administrator added that R1 acknowledged the situation and the pet remained at the facility for approximately three weeks before being rehomed as agreed.

Administrator emphasized that all residents, including R1, are required to sign an Admissions Agreement and a House Rules policy, which clearly prohibits pets on the premises. Administrator also cited legal concerns, noting that pets could pose a liability risk if they were to injure another resident or guest.

Continued on LIC 9099-C.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20250717143749

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: CALIFORNIA MANOR GUEST HOME #1	FACILITY NUMBER: 331880633
	VISIT DATE: 08/29/2025

NARRATIVE

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A review of facility records confirmed that 12 out of 12 residents had signed both the Admissions Agreement and House Rules, with no exceptions. Interviews with four of five residents confirmed that they had signed and were familiar with the House Rules, including the facility’s no-pets policy. Interview with Resident 1 (R1), stated they were under the impression that their pet was permitted to remain at the facility permanently, based on a verbal assurance from an unidentified man. However, R1 was unable to name or describe the individual. Additionally, R1 acknowledged that they had signed the Admissions Agreement and the House Rules, which advise of the pet restriction.

Based on observation, record review, client, and staff interviews, the allegations that facility staff is locking the refrigerator at night time and staff does not allow residents to keep their pets is unfounded. A finding that the allegation is unfounded meaning that the allegation was false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted where a copy of this report was provided to facility representative.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2025

LIC9099 (FAS) - (06/04)

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