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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366412378
Report Date: 03/28/2026
Date Signed: 03/28/2026 01:17:22 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
09/23/2024 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240923165457
FACILITY NAME:CASA DE AMELIA ARFFACILITY NUMBER:
366412378
ADMINISTRATOR:GLEN A. SMITHFACILITY TYPE:
735
ADDRESS:7650 JADEITE AVETELEPHONE:
(909) 476-1938
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:4CENSUS: 3DATE:
03/28/2026
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH: Serrena OrnelasTIME COMPLETED:
01:33 PM
ALLEGATION(S):
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Staff did not supervise residents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Caregiver Serrena Ornelas and explained the purpose of the visit regarding the allegations stated above.

First allegation: Staff did not supervise residents. Regarding the allegation stated above, LPA conducted an interview with Staff #1 and Staff #2 regarding the alleged allegation and S#1, and S#2 denied the allegation of leaving clients unsupervised. S#1 and S#2 informed LPA that clients are always supervised by staff and not left alone. Staff informed LPA that during the outing staff and clients stayed at a hotel suite where sleeping arrangements were discussed with the clients. Staff #1 and Staff #2 also denied having any clients sleep on the floor during the outing. LPA conducted interviews with Client #1, Client #2, and Client #3, regarding the allegation stated above and C#1-3 reported to LPA that staff did not leave them unsupervised during the time of their outing. In addition, C#1-3 informed to LPA that there is at least one staff member always supervising them.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2026
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-20240923165457
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: CASA DE AMELIA ARF
FACILITY NUMBER: 366412378
VISIT DATE: 03/28/2026
NARRATIVE
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 Client #1-3 also informed LPA that during their outing staff did not make any residents sleep on the floor. Based on corroborating evidence LPA has determined that the above allegation is 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 Facility Caregiver Serrena Ornelas at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2