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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336408317
Report Date: 03/13/2023
Date Signed: 03/13/2023 03:41:01 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/08/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230308162327
FACILITY NAME:ANGELVIEW CARE HOMES, INC. @ SHORELINEFACILITY NUMBER:
336408317
ADMINISTRATOR:FAITH AUMENTADO, R.N.FACILITY TYPE:
735
ADDRESS:25830 SHORELINE STREETTELEPHONE:
(951) 485-8065
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92551
CAPACITY:4CENSUS: 4DATE:
03/13/2023
UNANNOUNCEDTIME BEGAN:
01:09 PM
MET WITH:Lolita De Villa, CaregiverTIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff physically assaulted resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to conduct an investigation into the above allegation. LPA met with Caregiver Lolita De Villa, and toured the facility. LPA interviewed Administrator May Boco later after they arrived while LPA was inside the facility. LPA then reviewed documents in relation to Client One (C1).

It was alleged that Client 1 (C1) was physically assulted by Staff One (S1). S1 was allegedly to have hit C1's head and arm due to C1 not getting out of bed in time for dinner. C1 was reported to receive a bruise on their right elbow in relation to the incident.

Continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
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-20230308162327
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGELVIEW CARE HOMES, INC. @ SHORELINE
FACILITY NUMBER: 336408317
VISIT DATE: 03/13/2023
NARRATIVE
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LPA conducted interviews with C1, and S1, and as a result of the interviews, it was revealed that C1 was not physically struck by S1 as previously reported. This complaint was found Unsubstantiated. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted where a copy of this report was discussed with and provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2