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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530232
Report Date: 02/25/2026
Date Signed: 02/25/2026 02:08:36 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/04/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260204160340
FACILITY NAME:PASSION RESIDENTIAL HOMEFACILITY NUMBER:
365530232
ADMINISTRATOR:RUCIBIGANGO, OLIVIAFACILITY TYPE:
735
ADDRESS:11869 ANTLER PEAK CTTELEPHONE:
(408) 656-8403
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91737
CAPACITY:6CENSUS: 4DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:John Kasendwa- DSP/CaregiverTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Licensee neglected to keep residents room clean, sanitary and in good repair.
Licensee does not have a working smoke detector.
Staff are not meeting the needs of the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with DSP/Caregiver John Kasendwa and explained the purpose of the visit regarding the allegations listed above.

First allegation: Licensee neglected to keep residents room clean, sanitary and in good repair. Regarding the allegation, LPA met with Staff #1 LPA went over the alleged allegation with Staff #1 and Staff #1 informed LPA that Client #1 does not allow staff into client’s room. Staff #1 accompanied LPA to Client#1 room LPA was able to conduct a walkthrough of Clients #1 room by permission given from Client #1. During the walkthrough C#1 informed LPA that client does not want anyone else in the room as client does not allow staff in clients room for any circumstances. During the walkthrough LPA asked Client #1 if staff assist client with the cleaning of clients’ room and Client #1 informed LPA that staff does not have permission to enter clients’ bedroom. During the inspection LPA observed client’s room to be disorganized and cluttered.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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-20260204160340
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PASSION RESIDENTIAL HOME
FACILITY NUMBER: 365530232
VISIT DATE: 02/25/2026
NARRATIVE
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Second allegation: Licensee does not have a working smoke detector. Regarding the allegation, LPA conducted an interview with Staff #1 LPA went over the alleged allegation with Staff #1 and informed Staff #1 that a walkthrough of Client #1 bedroom will need to be conducted. Staff #1 informed LPA that permission from Client #1 will be required due to client’s aggressive behavior. Client #1 granted LPA with permission to enter client’s room during the walkthrough LPA observed a smoke detector to be present and in working condition. LPA asked Client #1 about the missing smoke detector and Client #1 informed LPA that the last smoke detector made noise and client decided to pull it out.

Third allegation: Staff are not meeting the needs of the residents. Regarding the allegation stated above, LPA conducted an interview with Staff #1, Staff #2, and Staff #3, LPA went over the alleged allegation with Staff#1-3. During the interview Staff #1-3 informed LPA that facility is following Client#1 needs based clients individual plan however, Client #1 does not comply and has extreme aggressive behaviors when redirected. On 2/9/2026, LPA conducted a walkthrough of Client#1 room during the walkthrough LPA witnessed Client #1 who became verbally aggressive with Staff #1 after Staff #1 attempted to accompany LPA on the walkthrough. Based on corroborating evidence the department has determined that the above allegations are Unsubstantiated, meaning that 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.
An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to DSP/Caregiver John Kasendwa.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2