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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 360911547
Report Date: 10/21/2025
Date Signed: 02/12/2026 04:16:15 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
08/27/2025 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20250827081809
FACILITY NAME:ORCHID COURT, INC.FACILITY NUMBER:
360911547
ADMINISTRATOR:GOSUICO, CLODOVEO IIIFACILITY TYPE:
735
ADDRESS:307 S. ARROWHEAD AVENUETELEPHONE:
(909) 884-3044
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92408
CAPACITY:80CENSUS: 76DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator, Goerge GosuicoTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff does not provide adequate supervision resulting in resident wandering away from facility
INVESTIGATION FINDINGS:
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On 10/21/2025 at 10:10AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA discussed the purpose of the visit with Admimistrator, George Gosuico. The investigation consisted of interviews and record review.
The allegation of staff does not provide adequate supervision resulting in resident wandering away from facility:
Staff stated that the facility is "open" where residents can leave/enter independently. Resident 1 (R1) physician's report indicates that they can leave the facility independently. Staff stated that R1 leaves frequently, informs staff and always returns later. R1 stated that they leave the facility, but always returns. On 08/26/2025, the facility was notified that R1 was taken to a crisis center and the facility staff picked up R1 the following day. Staff denied the allegation and stated that there is adequate supervision. Based on interview and record review, this allegation is UNSUBSTANTIATED. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where this report LIC9099 was discussed and a copy was provided to staff.



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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 2
Control Number 56-AS-20250827081809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ORCHID COURT, INC.
FACILITY NUMBER: 360911547
VISIT DATE: 10/21/2025
NARRATIVE
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SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2