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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880822
Report Date: 04/30/2026
Date Signed: 04/30/2026 04:46:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
04/22/2026 and conducted by Evaluator Andrew Martinez
COMPLAINT CONTROL NUMBER: 56-AS-20260422082110

FACILITY NAME:KUN BAI CARE #2 HOMEFACILITY NUMBER:
331880822
ADMINISTRATOR:BRANDON MARQUEZ-GUTIERREZFACILITY TYPE:
740
ADDRESS:4091 ELDERBERRY RIDGETELEPHONE:
(909) 994-6199
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:6CENSUS: 3DATE:
04/30/2026
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Caregiver, Rosalimo SarellanoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff is not able to communicate with residents in care.
INVESTIGATION FINDINGS:
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Regarding the second allegation - Staff is not able to communicate with residents in care: LPA observed S1 was unable to effectively communicate with residents regarding their needs, care, or supervision. LPA attempted to communicate with S1 regarding the allegations mentioned while asking basic questions related to care and supervision. S1 was unable to understand or respond to LPA’s questions in English. LPA made multiple attempts to communicate using simple and direct language; however, S1 was unable to demonstrate an understanding of the questions asked without using a translator application on their cellular device to communicate. S1 telephoned Administrator, Brandon Marquez-Gutierrez (S2), to inform them of LPA's arrival. LPA was informed by S2 that they and Licensee, Sandy Zhao (S3), were unanable to be present at the facility today. LPA's reqeuests had to be translated in Spanish by S2 to S1.
Based on investigation, the above allegation is SUBSTANTIATED. A SUBSTANTIATED finding is a finding defined as a violation that has occurred based on the preponderance of available evidence. An exit interview was conducted where this report LIC 9099A, LIC 9099D, and Appeal Rights were discussed and a copies were provided to Caregiver, Rosalimo Sarellano.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Andrew Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20260422082110
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: KUN BAI CARE #2 HOME
FACILITY NUMBER: 331880822
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/14/2026
Section Cited
CCR
87411(a)
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87411(a)Facility personnel shall at all times be... competent to provide the services necessary to meet resident needs... The licensing agency may require any facility to provide additional staff whenever it determines...the facility require... additional staff for the provision of adequate services.
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Licensee shall ensure that all staff have the ability to effectively communicate with residents and Licensing staff in order to provide adequate care and supervision. Licensee shall submit a written plan to Licensing describing how communication competency will be ensured for all staff
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Based on observations and attempted interviews, S1 demonstrated an inability to effectively communicate with residents and LPA, impactaing their ability to provide adequate care and supervision to residents, This poses a potential health and safety risk to residents in care.
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along with an updated LIC 500 Personnel Report indicating staff's full names as they appear on Guardian that coincides with written plan to provide adequate care and supervision to residents by POC due date.
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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: Karen Clemons
LICENSING EVALUATOR NAME: Andrew Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4