336405884-10-15-2025-18-AS-RORN-DMPMWV-20251022095856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336405884
Report Date: 10/15/2025
Date Signed: 10/15/2025 01:18:28 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
11/30/2022 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221130131306

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - A1		FACILITY NUMBER:	336405884
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14265 NASON STREET		TELEPHONE:	(951) 601-9100
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	22	CENSUS: 19	DATE:	10/15/2025
		UNANNOUNCED	TIME BEGAN:	12:29 PM
MET WITH:	Jonathan Fuentes - Assistant Manager		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff does not treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint investigation visit regarding the above allegation. LPA met with Jonathan Fuentes and explained the reason for the visit.

The investigation consisted of the following: On 12/7/22 LPA Torres conducted an initial complaint investigation visit. On 10/13/25 LPA Flores contacted administrator and requested copies of resident #1(R1)’s admission agreement, physician’s report, needs and care appraisal, identification and emergency information sheet, power of attorney (POA) signed 5/20/22, incident reports, and death report. On 10/14/25 LPA Flores conducted interviews with 5 staff over the phone and R1’s power of attorney (POA). On 12/15/25 LPA Flores conducted interviews with 6 residents and delivered findings.

(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

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-20221130131306

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: INTEGRATED CARE COMMUNITIES - A1	FACILITY NUMBER: 336405884
	VISIT DATE: 10/15/2025

NARRATIVE

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The investigation revealed the following: Regarding allegation: Staff does not treat resident with respect. It is alleged that staff are treating R1 inappropriately and in a rough manner. Interviews with residents revealed staff are respectful and gentle when assisting with care. Interviews with staff revealed they have not observed residents treated in a rough or disrespectful manner. It has not been reported to any staff of residents being mistreated either by staff or residents and staff treat the residents with respect. Per staff they are provided training on resident’s personal rights yearly. Interview with POA revealed they were satisfied with the care and there were no concerns regarding the staff. Documents reviewed revealed R1 was admitted on 5/9/22. R1 is no longer residing at the facility therefore an interview was not conducted.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Jonathan Fuentes and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025

LIC9099 (FAS) - (06/04)

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