331881012-9-23-2025-18-AS-APEZ-DMUKE7-20251027074952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881012
Report Date: 09/23/2025
Date Signed: 09/23/2025 06:18:22 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
09/08/2025 and conducted by Evaluator Valerie Flores

COMPLAINT CONTROL NUMBER: 18-AS-20250908094228

FACILITY NAME:	LOVABLE HOME CARE FOR DISABLED ADULTS		FACILITY NUMBER:	331881012
ADMINISTRATOR:	SEYMORE, TONISHA		FACILITY TYPE:	735
ADDRESS:	26594 BYRON CIRCLE		TELEPHONE:	(714) 341-4542
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92584
CAPACITY:	4	CENSUS: 4	DATE:	09/23/2025
		UNANNOUNCED	TIME BEGAN:	03:47 PM
MET WITH:	Administrator, Tonisha Seymore		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Staff hit resident in care

INVESTIGATION FINDINGS:

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On 9/23/2025, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of delivering an investigative finding into the allegation listed above. LPA Flores identified herself and discussed the purpose of the visit with Administrator, Tonisha Seymore. The investigation consisted of record reviews and interviews.

Information received alleged Staff #1 (S1) hit resident #1 (R1) with a wooden stick. Interviews conducted with Staff #2 (S2) and Staff #3 (S3), reported working at the facility on 11/17/2024. At approximately 1400 hours, S2 and S3 overheard R1 and S1 yelling. S2 and S3 reportedly rushed to R1’s room and observed S1 striking R1 with a wooden stick on the head, legs, and upper back region. Interview conducted with Staff #4 (S4), reported they were approaching the facility’s front door and overheard R1 yelling and cursing at S1.

(Continue to LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

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-20250908094228

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: LOVABLE HOME CARE FOR DISABLED ADULTS	FACILITY NUMBER: 331881012
	VISIT DATE: 09/23/2025

NARRATIVE

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(Continuation from LIC9099)
S4 reportedly asked S1 what was happening and S1 explained they attempted to conduct a CPI hold on R1 but were unsuccessful. Interview conducted with S1 and Administrator reported R1 experiencing a behavioral episode causing R1 to bite S1 on the hand and S1 sustaining a knot on the side of S1’s eye. S1 attempted to conduct a CPI on R1 but the attempt was unsuccessful. Through the interview, S1 reported calling out for additional staff assistance. S1 alleged S2 and S3 did not respond to S1’s request for assistance. S1 denies ever hitting R1. S1 and Administrator reports S1 resigned from the facility due to family matters. An interview conducted with Administrator, reported observing S2 and S3 flirting in the kitchen area and overheard S1 yelling for help. Administrator observed the S2 and S3 flirting through the facility’s nest camera located on the kitchen countertop. The Administrator attempted to retrieve video surveillance of the incident through google nest but discovered surveillance video is stored for a maximum duration of 60 days before the video goes through an automatic factory reset. LPA attempted to conduct an interview with R1. R1 is unable to provide additional information to the complaint allegation as R1’s can only form short and simple word sentences. Interviews conducted with Resident #2 (R2) and Resident #3 (R3) could not provide additional information pertaining to the complaint investigation. An interview conducted with R2 reported S1 is very nice and R2 has never observed S1 hit nor yell at the residents. Records review conducted of R1’s daily observation notes did not document R1 experiencing a behavioral episode on 11/17/2024. According to Administrator, the behavioral episode should have been documented by the on-shift staff.

Therefore, due to lack of corroborating statements and insufficient information, the allegation of staff hit resident in care is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report was reviewed and provided to Administrator, Tonisha Seymore.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2025

LIC9099 (FAS) - (06/04)

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