<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413179
Report Date: 12/26/2025
Date Signed: 12/26/2025 01:59:28 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
04/24/2024 and conducted by Evaluator Renese Howell-Small
COMPLAINT CONTROL NUMBER: 56-AS-20240424154333
FACILITY NAME:ALYZA HOMEFACILITY NUMBER:
366413179
ADMINISTRATOR:FIGURACION, MARIOFACILITY TYPE:
735
ADDRESS:5062 RODEO STREETTELEPHONE:
(909) 270-3738
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:6CENSUS: 4DATE:
12/26/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:FrancisTIME COMPLETED:
02:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not administering client's medication as prescribed
Staff do not inform client's authorized representatives of medication being administered
Staff keep client in isolation
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/26/2025 at 10:20AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Assistant Administrator, Francis Pastorfide. The investigation consisted of interviews and record review.

In regards to the allegation of staff are not administering client's medication as prescribed:
LPA interviewed three (3) staff and observed three (3) non-verbal clients in care. LPA reviewed Client 1 (C1) Medical Administration Records (MAR) and did not observe any discrepancies. Staff denied the allegation and stated that clients are given their medication and do not typically refuse. Based on interviews and records review,this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff do not inform client's authorized representatives of medication being administered:
LPA interviewed three (3) staff, they stated that they are not trained to notify clients' representatives when
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025
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-20240424154333
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: ALYZA HOME
FACILITY NUMBER: 366413179
VISIT DATE: 12/26/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
medication is administered. Staff will document in the MAR and contact the physician when needed. The facility's Admission Agreement does not state that staff will notify representatives when medication is administered. Based on interviews and record review, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff keep client in isolation:
LPA conducted an interview with the relative of C1 and they stated that all of the allegations are false and C1 was happy at the facility. Staff denied the allegation. LPA observed the three (3) clients in care moving around the residence in a carefree manner. Based on interviews and observation, this allegation is UNSUBSTANTIATED.

During the month of 04/2024, the facility submitted the required incident reports detailing a medication error and other incidents involving a relative of C1.

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(s) occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C were discussed and copies were provided to staff, Tita "Caasi" Florentino.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2