<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881325
Report Date: 02/09/2026
Date Signed: 02/09/2026 04:31:34 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
08/09/2024 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240809171034
FACILITY NAME:A NANA'S LOVEFACILITY NUMBER:
331881325
ADMINISTRATOR:KIAMINI KHUMBUZILEFACILITY TYPE:
735
ADDRESS:1403 REEDS WAYTELEPHONE:
(951) 350-0354
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY:4CENSUS: 3DATE:
02/09/2026
UNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Kay Walker - DSPTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident was physically abused while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with DSP Kay Walker and explained the purpose for todays visit.

The investigation consisted of the following:

LPA obtained photo evidence of Client #1’s appearance upon admission, LPA interviewed 3 Staff (S1-S3) and 2 Clients (C3-C4), due to C2’s intellectual disability there was no interview conducted, C1 is no longer a client at facility and was unreachable prior to visit for interview.

(Continued on LI9099-C)


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
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 2
Control Number 18-AS-20240809171034
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: A NANA'S LOVE
FACILITY NUMBER: 331881325
VISIT DATE: 02/09/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following:
Allegation: Resident was physically abused while in care.
It is alleged that C1 was physically assaulted by staff and lost a piece of equipment of their tooth during the assault. LPA interviewed 3 staff and each denied the allegation, S1 and S3 confirmed that C1 was a client here and since this complaint has apologized for lying about the allegation and has asked to be able to return to facility, additionally both staff stated that C1 had previously had that part of their tooth missing before moving into facility and photos via text message to LPA. LPA interviewed 2 clients and each denied the allegation and stated that staff have never yelled at, cursed at or physically abused them. LPA spoke with Regional Center Representative who investigated this complaint, and they confirmed that this client confessed about fabricating the story and allegation and they have photos that confirm that client was missing the part of the tooth prior to being admitted to facility and will send photos along with a copy of the incident report to LPA.

Based on statements and interviews conducted with staff, clients, and Regional Center Representative, review of C1’s files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 02/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2