331881317-3-28-2026-18-AS-RORN-DSVT3Y-20260406142306

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881317
Report Date: 03/28/2026
Date Signed: 03/28/2026 01:41:11 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
04/10/2023 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230410164303

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: 15	DATE:	03/28/2026
		UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Marites Boyer Administrator		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff are falsifying personnel records.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Marites Boyer who assisted with today’s visit.

The investigation consisted of the following: During the initial visit conducted on 04/17/2023, (LPA) Yolanda Delgado conducted an unannounced visit to the facility to initiate a complaint investigation. LPA interviewed five (5) staff and requested and obtained copies of pertinent documentation. During today’s visit LPA Gutierrez obtained resident roster, staff roster, S1 training certificate, copies of CPR/First aid, and CPI certificates. LPA interviewed Administrator, staff #1- staff #2 (S1-S2) over the telephone, staff #3-staff #5 at facility and delivered findings.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2026

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-20230410164303

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: 03/28/2026

NARRATIVE

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In regard to the allegation” Staff are falsifying personnel records”, It is alleged that facility manufactures and distributes First aid/CPR, and CPI cards. During interview with Administrator, and staff six (6) out of six (6) stated that they have never falsified any certificates or had any staff give a fake certificate. Administrator stated that they are too big of a facility to do that and get in trouble for that. S1 stated that all cards are issued through the American Red Cross, and the facility submits them for the certificates. LPA completed a file check on six (6) staff members and verified all First aid/CPR cards online at American Red Cross certification lookup, and National CPR foundation lookup. All six (6) certificates are valid. LPA also obtained a valid certificate for S1 CPI trainer certification valid until 04/2027. Administrator stated that a CPI card is not required on a level 3 home, but staff still completes course.

Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted , and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2026

LIC9099 (FAS) - (06/04)

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