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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880850
Report Date: 02/18/2026
Date Signed: 02/18/2026 12:05:16 PM

Substantiated


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
02/12/2026 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260212093725
FACILITY NAME:SALEM HOMEFACILITY NUMBER:
361880850
ADMINISTRATOR:KARAMOY, DINAFACILITY TYPE:
735
ADDRESS:18305 SALEM LANETELEPHONE:
(760) 596-1472
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:4CENSUS: 4DATE:
02/18/2026
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Dina Karamoy, LicenseeTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Facility is in disrepair
Facility is not kept free of rodents
INVESTIGATION FINDINGS:
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On February 18, 2026, Licensing Program Analysts (LPA) Eldin Serrano visited the facility to investigate the above-mentioned allegations and deliver findings. LPA met with Licensee Dina Karamoy to discuss the purpose of the visit. The investigation consisted of interviewing relevant parties and LPA observation.

Allegation #1: Facility is in disrepair – Based on interviews with relevant parties it was confirmed that the facility kitchen sink drainpipe was leaking and the bathroom downstairs had evidence of water damage on the ceiling originating from the upstairs bathroom. LPA observed a warning sign on the kitchen window advising not to use the sink due to its condition. Additionally, LPA noted water damage in the bathroom downstairs, evidenced by paint discoloration and a small hole in the ceiling.

Allegation #2: Facility is not kept free of rodents – The interviewed party confirmed rodent activity. However, the facility did not provide a pest control invoice or a monitoring contract to address potential future infestations. No evidence of rodent droppings was observed during the inspection, though this does not rule out the presence of rodents.

******continue on LIC9099C******
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
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 56-AS-20260212093725
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: SALEM HOME
FACILITY NUMBER: 361880850
VISIT DATE: 02/18/2026
NARRATIVE
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Based on interviews, the preponderance of evidence standard has been met, therefore, the allegations are substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 1).

An exit interview was conducted, where this report, LIC9099, LIC9099D along with appeal rights, were provided to the Licensee Dina Karamoy.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20260212093725
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: SALEM HOME
FACILITY NUMBER: 361880850
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/18/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/25/2026
Section Cited
CCR
80087(a)
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Title 22, Division 6 Chapter 1 Article 07. Physical Environment 80087 (a)Buildings and Grounds (a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.This requirement is not met as evidence by:
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The licensee shall provide an invoice or receipt from a licensed plumber confirming that the kitchen sink drainpipe and the downstairs bathroom ceiling have been repaired by the plan of correction (POC) due date.
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Based on observation, the licensee did not comply with the section cited above by not ensuring that the facility kitchen sink drainpipe and the downstairs bathroom ceiling are in good repair which poses a potential health, safety or personal rights risk to persons in care.
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Type B
02/25/2026
Section Cited
CCR
80076(a)(17)
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Title 22, Division 6 Chapter 1Article 06. Continuing Requirements 80076 (a)(17) Food Services (a) In facilities providing meals to clients, the following shall apply:
(17)All kitchen, food preparation, and storage areas shall be kept clean, free of litter and rubbish, and measures shall be taken to keep all such areas free of rodents, and other vermin.This requirement is not met as evidence by:
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The licensee will submit a copy of the pest control invoice and monitoring contract by the plan of correction (POC) due date to address potential rodent issues.
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Based on observation, the licensee did not comply with the section cited above by not ensuring that the facility is free of rodent/ mice activities which poses a potential health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 02/18/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3