336426544-6-15-2026-18-AS-PMAA-DVHUM3-20260629154140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426544
Report Date: 06/15/2026
Date Signed: 06/15/2026 12:45:59 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
02/23/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20240223150731

FACILITY NAME:	MORENO SUNBIRD RESIDENTIAL CARE		FACILITY NUMBER:	336426544
ADMINISTRATOR:	KAIRU, MUMBI		FACILITY TYPE:	735
ADDRESS:	13215 SUNBIRD DR.		TELEPHONE:	(951) 842-2756
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY:	6	CENSUS: 1	DATE:	06/15/2026
		UNANNOUNCED	TIME BEGAN:	09:21 AM
MET WITH:	KHUMBUZILE DLAMINI		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff neglected resident while in care which resulted in overdose/hospitalization.
Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On June 15, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. LPA met with the staff, KhumbuZile Dlamini, and explained the purpose of the visit.

The complaint investigations consisted of the following. On June 15, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 06/01/26) and the Client Roster (dated 06/01/26). The Department reviewed and collected documents for Client 1 (C1), including the Admission Agrement; the physician's Report dated 03/07/2023; the Medication Administration Records (MAR) dated 01/26/2024 to 2/15/2024; the Unusual Incident Report dated 02/17/2024; and staff training on the client's personal rights and Medication training. The Department interviewed one staff member (S1) and one client (C2). The Department was unable to interview Client 1 (C1) because C1 no longer resides at the facility. On the same day, the department attempted to interview client C2, but was unable because of C2's health condition.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

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 3

Control Number 18-AS-20240223150731

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: MORENO SUNBIRD RESIDENTIAL CARE	FACILITY NUMBER: 336426544
	VISIT DATE: 06/15/2026

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

Allegation #1: Staff neglected resident while in care which resulted in overdose/hospitalization.

The complaint alleged that the client was brought to Riverside University Hospital System (RUHS) on February 15, 2024, due to concerns about a possible overdose. On June 15, 2026, the department interviewed staff member S1, who denied the allegations, stating that the client did not experience an overdose. The facility contacted Medical Emergency (ME) on February 15 because the client was unable to walk steadily. During the call, S1 provided ME with the client's history and confirmed that the client had received only the prescribed medications in their exact doses that day.

On June 15, 2026, the department also interviewed the Placement Agency (PA) regarding the complaint. The PA reported receiving an Unusual Incident Report and assessing the client upon receipt of the complaint. The department's review of the client's records for the RUHS confirmed admission on February 15, 2024. The department also examined the client’s Medication Administration Records from January 26 to February 15, 2024, and found no discrepancies. On June 15, 2026, the department was unable to interview client C1 because C1 no longer resides at the facility. On the same day, the department attempted to interview C2 but was unable to do so due to C2's health condition.

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.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20240223150731

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: MORENO SUNBIRD RESIDENTIAL CARE	FACILITY NUMBER: 336426544
	VISIT DATE: 06/15/2026

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

Allegation #2: Staff mismanaged resident’s medication.

The complaint stated that staff were unsure how the client overdosed or whether appropriate medication management was provided. On June 15, 2026, the department interviewed a staff member (S1), who denied the allegation and asserted that the client did not overdose.

The facility called Medical Emergency (ME) on February 15, 2024, due to client C1’s inability to walk steadily. S1 stated on the same day, S1 assisted C1 with their medications as prescribed by the doctor. The medications were organized in a packet that required punching to ensure the clients took them, making it impossible for a client to overdose on the prescribed medications.

On June 15, 2026, the department reviewed the client's Medication Administration Records, dated from January 26 to February 15, 2024, and found no discrepancies. During the review of the Riverside University Hospital System (RUHS), it was found that client C1 was admitted to RUHS on February 15, 2024. The department was unable to interview client C1 because they no longer resided at the facility. Additionally, the department attempted to interview client C2 but was unable to do so due to their health condition.

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.

No deficiencies were cited.

An exit interview was conducted, A copy of the report was provided to the staff, KhumbuZile Dlamini.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3