336423314-5-24-2026-18-AS-RORN-DUHLJN-20260528084812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423314
Report Date: 05/24/2026
Date Signed: 05/24/2026 04:00:31 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
03/22/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240322130839

FACILITY NAME:	FAMOUS HOME		FACILITY NUMBER:	336423314
ADMINISTRATOR:	FEDELIA B. DAIZ		FACILITY TYPE:	740
ADDRESS:	26690 MCCLURE COURT		TELEPHONE:	(951) 943-6049
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	6	CENSUS: 5	DATE:	05/24/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Fedelia Daiz - Licensee		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Licensee is not following proper eviction procedures with resident in care.
Staff retaliated against resident in care.
Staff do not ensure that resident is provided with medical equipment as necessary.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera made an unannounced subsequent visit to investigate the above-mentioned allegations. LPA met with Licensee Fedelia Daiz and explained the purpose of the visit.

The investigation consisted of the following:
On 3/26/24 LPA Yolanda Delgado interviewed one (1) staff and requested and obtained copies of pertinent documentation.
On 5/22/26 LPA Herrera conducted phone interview with 1 Staff (S1).
During todays visit LPA Herrera conducted interview with 1 Staff (S2), 4 Residents (R1-R4), and delivered findings on the reported allegations.

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2026

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-20240322130839

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: FAMOUS HOME	FACILITY NUMBER: 336423314
	VISIT DATE: 05/24/2026

NARRATIVE

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The investigation revealed the following:
Allegation: Licensee is not following proper eviction procedures with resident in care.
It is alleged that R1 was not issued with an eviction notice and staff were verbally telling R1 they can no longer live at facility and taking R1 to look at other facilities for R1 to be transferred to. LPA interviewed 2 Staff and each denied the allegation stating that they did not evict R1 from facility and that R1 left because they were unhappy here and found another facility to reside at, R1 self-discharged from facility. LPA interviewed 4 Residents and each denied the allegation and stated that they have never been issued an eviction noticed or been threatened with an eviction.

Allegation: Staff retaliated against resident in care.
It is alleged that R1 is being evicted due to complaints and concerns that have been brought up to the Administrator. LPA interviewed 2 Staff and each denied the allegation stating that they have never retaliated against any of the residents and have never witnessed other staff do this. LPA interviewed 4 Residents and each denied the allegation and stated that they have never been retaliated against, R1 and R3 stated they have brought up complaints to staff before and they were not treated any different after voicing their complaints/concerns.

Allegation: Staff do not ensure that resident is provided with medical equipment as necessary.
It is alleged that R1 needs a nebulizer for their condition and staff have not assisted in ensuring R1 has the needed medical equipment. LPA interviewed 2 Staff and each denied the allegation stating that they make sure resident have all the medical equipment, their medication and attend their medical appointments as needed. Staff stated that R1 always kept their nebulizer on hand while at the facility and this concern/issue was never brought to their attention. LPA interviewed 4 Residents and each denied the allegation and stated that they have never had an issue with this and staff help with all their medical needs.

Based on statements and interviews conducted, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are 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: 05/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2026

LIC9099 (FAS) - (06/04)

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