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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530250
Report Date: 11/04/2025
Date Signed: 11/04/2025 11:03:44 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/29/2025 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20251029170740
FACILITY NAME:CROSSROADS ADULT DAY CARE CENTERFACILITY NUMBER:
365530250
ADMINISTRATOR:ANDRADE, AUDREYFACILITY TYPE:
775
ADDRESS:11130 WHITE BIRCH DRTELEPHONE:
(909) 481-9663
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:110CENSUS: 93DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:David Panowicz, Program DirectorTIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Client was inappropriately touched by staff while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with Program Director Panowicz and explained the elements of the complaint.

Allegation #1 - LPA Prieto interviewed staff #1 (S1), S2, S3, and S4, all so state that they have not witnessed any inappropriate touching by staff to clients at the program. LPA Interview resident #1 (R), in question, who made a previous statement that inappropriate was false and later recanted that statement. R1's representative was interviewed who stated that the statement of inappropriate touching was made and later recanted. LPA obtained documentation from the Day Program, relating to R1, and the attention seeking behaviors displayed by R1, along with combative behavior with false statements made by R1.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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-20251029170740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: CROSSROADS ADULT DAY CARE CENTER
FACILITY NUMBER: 365530250
VISIT DATE: 11/04/2025
NARRATIVE
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Based on interviews and documentation obtained during this investigation, LPA could not corroborate the allegation the staff inappropriately touched client while in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Program Director Panowicz and a copy of this report was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2