336408482-11-5-2025-18-AS-RORN-DP2QSZ-20251204112621

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336408482
Report Date: 11/05/2025
Date Signed: 11/05/2025 01:15:16 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
12/17/2021 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20211217154654

FACILITY NAME:	CUNNINGHAM RES. CARE HOME III		FACILITY NUMBER:	336408482
ADMINISTRATOR:	ALICIA CUNNINGHAM		FACILITY TYPE:	740
ADDRESS:	24702 ORMISTADRIVE		TELEPHONE:	(951) 485-4697
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY:	6	CENSUS: 3	DATE:	11/05/2025
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Alicia Cunningham		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Facility did not allow resident to have a visitor at the facility.

INVESTIGATION FINDINGS:

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On November 5, 2025, at 9:30 a.m., Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit and delivered the findings. LPA met with Administrator Alicia Cunningham and explained the purpose of the visit. LPA and the Administrator toured the facility.

The investigation consisted of the following: On November 5, 2025, LPA Richard requested and obtained the residents' and staff roster, the Admission Agreement, Physician reports, and the facility's Emergency and Disaster Plan for a Resident Care Facility for the Elderly (dated November 5, 2025). LPA interviewed the Administrator (A1), two staff members #1-2 (S1-S2), and one resident #2 (R2). LPA attempted to interview residents R3 and R4, but they refused to participate. LPA was unable to interview R1 because R1 passed away in 2023.

Continued Report LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

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 3

Control Number 18-AS-20211217154654

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: CUNNINGHAM RES. CARE HOME III	FACILITY NUMBER: 336408482
	VISIT DATE: 11/05/2025

NARRATIVE

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Allegation: The Facility did not allow resident to have a visitor at the facility.

The complaint alleged that on December 17, 2021, the facility did not allow a resident to have a visitor for the purpose of providing palliative care. On November 5, 2025, from 10:00 AM to 11:30 AM, LPA Richard interviewed Administrator #1 (A1), who denied the allegation. A1 explained that the facility was following the Centers for Disease Control and Prevention (CDC) guidelines because the representative from the care agency was unable to provide documentation confirming a negative COVID-19 test.

Afterward, A1 contacted the agency, which then sent a representative with a document showing a negative COVID-19 test result, allowing the representative to provide care to the residents. During the same time frame, LPA interviewed two staff members (S1 and S2), who also denied the allegation and emphasized their commitment to keeping the residents safe during the pandemic.

LPA also interviewed one resident #2 (R2), who expressed satisfaction with how the facility managed the pandemic, stating that they felt safe throughout the lockdown. LPA attempted to interview two additional residents (R3 and R4), but both refused to participate. LPA observed that the facility has an approved and current Emergency and Disaster Plan on file.

Report Continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20211217154654

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: CUNNINGHAM RES. CARE HOME III	FACILITY NUMBER: 336408482
	VISIT DATE: 11/05/2025

NARRATIVE

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Based on the information collected from the facility, interviews, and records reviewed, LPA found no evidence to support the above allegations. Although the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegation is unsubstantiated.

No deficiencies cited.

An exit interview was conducted. A copy of this report was provided to the Administrator, Alicia Cunningham.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025

LIC9099 (FAS) - (06/04)

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