331881317-9-16-2025-18-AS-RORN-DLSNDL-20250923102232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881317
Report Date: 09/16/2025
Date Signed: 09/16/2025 04:06:29 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
09/14/2022 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20220914103751

FACILITY NAME:	MISSION BELL ADULT RESIDENTIAL CARE HOME		FACILITY NUMBER:	331881317
ADMINISTRATOR:	BOYER, MARITES		FACILITY TYPE:	735
ADDRESS:	435 IDYLLWILD DRIVE		TELEPHONE:	(951) 654-0774
CITY:	SAN JACINTO	STATE: CA	ZIP CODE:	92583
CAPACITY:	15	CENSUS: 14	DATE:	09/16/2025
		UNANNOUNCED	TIME BEGAN:	03:38 PM
MET WITH:	Boyer Marites		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff member inappropriately handled resident while in care

INVESTIGATION FINDINGS:

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On 09/16/2025, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit at this facility. LPA met with the Administrator, Marites Boyer. LPA explained that the purpose of this visit is to complete the investigation and deliver findings for the allegation mentioned above. LPA was granted access to the facility.

Investigation included: interviews with Administrator (A1), client interviews (C1-C5), and staff interviews (S1-S3). A review of the following documents: client roster, personnel roster, service records for (S1-S3), facility staff in-service trainings, and other relevant records related to this complaint, including (C1’s) Physician Report LIC 602A (dated 11/09/23), Needs of Service Plan (dated 2022-2023), Medication Administration Record (MAR), a tour of the facility, the facility's Special Incident Report (dated 11/10/2022).

Evaluation Report continues LIC 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

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-20220914103751

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: MISSION BELL ADULT RESIDENTIAL CARE HOME	FACILITY NUMBER: 331881317
	VISIT DATE: 09/16/2025

NARRATIVE

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Allegation #1: Facility staff members inappropriately handled the residents while in care.

The complaint alleges that a staff member pulled the client’s hair without any apparent reason. On September 16, 2025, between 10:00 AM and 3:00 PM, the Licensing Program Analyst (LPA) interviewed the Administrator (A1), who denied the allegation. A1 stated that the client never mentioned any incident involving hair-pulling to them. A1 emphasized that all staff receive training on clients' rights and that any staff member found pulling a client’s hair would be terminated immediately, regardless of the circumstances.

During the same time frame on September 16, 2025, the LPA interviewed three staff members (S1, S2, S3), all of whom denied the allegation. They asserted that the clients have rights and that any staff member who abuses a client risk losing their job.

The LPA also interviewed five clients (C1, C2, C3, C4, C5). Five out of five clients denied the allegations, stating that the staff are respectful and there has been no inappropriate behavior during their time there. (C1-C2) stated that no staff member ever pulled their hair. They all stated that they love the staff.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220914103751

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: MISSION BELL ADULT RESIDENTIAL CARE HOME	FACILITY NUMBER: 331881317
	VISIT DATE: 09/16/2025

NARRATIVE

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On September 16, 2025, the LPA reviewed records of staff training, which included: Caregiver Training (dated June 23, 2023), Direct Care Orientation Training (dated June 13, 2023), Employee Orientation Training (dated June 13, 2023), Time and Attendance (dated June 9, 2023), and Clients' Rights (dated June 9, 2023). On 09/16/25, LPA called and attempted to talk to the alleged perpetrator but was unable to and left a voicemail message. On September 16, 2025, the LPA received documentation of the investigation report from the Inland Regional Center (IRC) dated June 9, 2023, about the allegation.

Based on information gathered, an inspection of the facility, observation, and interviews conducted, an analysis of records reviewed, the Department found no evidence to support the allegation mentioned above. 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.

No deficiencies cited.

Exit interview conducted. A copy of this report was provided to the Administrator Marites Boyer.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2025

LIC9099 (FAS) - (06/04)

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