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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881183
Report Date: 08/20/2026
Date Signed: 08/20/2026 02:36:32 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
06/18/2026 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20260618155138
FACILITY NAME:MIRIAM'S HOMECAREFACILITY NUMBER:
361881183
ADMINISTRATOR:GAD, ENRICOFACILITY TYPE:
740
ADDRESS:1635 HAMPSHIRE RDTELEPHONE:
(818) 912-0178
CITY:SAN BERNARDINOSTATE: CAZIP CODE:
92404
CAPACITY:6CENSUS: 2DATE:
08/20/2026
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Staff, Miriam NausedaTIME COMPLETED:
02:40 PM
ALLEGATION(S):
1
2
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8
9
Staff handles resident in a rough manner
INVESTIGATION FINDINGS:
1
2
3
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5
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8
9
10
11
12
13
On 08/20/2026 LIcensing Program Analyst (LPA) Renese Howell-Small arrived unannounced to the facility in order to deliver findings for the above allegation. LPA observed one (1) resident in care and one (1) resident was out of the facility.

The allegation that staff handles resident in a rough manner:
LPA interviewed two (2) residents and two (2) staff. Staff denied the allegation and stated that they assist the residents with what they need. Resident 1 (R1) is able to express their needs and communicate. R1 stated that they are treated well by staff. Resident 2 (R2) stated that staff take good care of the residents. LPA reviewed staff records which revealed that certifications and trainings were current. LPA reviewed the required documents for R1 and found the files to be complete. Based on interview and record review, this allegation is UNSUBSTANTIATED.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
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 2
Control Number 56-AS-20260618155138
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: MIRIAM'S HOMECARE
FACILITY NUMBER: 361881183
VISIT DATE: 08/20/2026
NARRATIVE
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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 and LIC9099C was discussed and a copy was provided to staff, Miriam Nauseda.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2