366425610-5-21-2026-56-AS-KCLS-DUJ5KQ-20260528200155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 05/21/2026
Date Signed: 05/21/2026 02:10:07 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
02/10/2026 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20260210101558

FACILITY NAME:	EXCELCARE		FACILITY NUMBER:	366425610
ADMINISTRATOR:	ANDERSON, DORRIS		FACILITY TYPE:	740
ADDRESS:	11400 POPLAR STREET		TELEPHONE:	(909) 796-4553
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	10	CENSUS: 4	DATE:	05/21/2026
		UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Administrator Dorris Anderson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident was not accorded dignity in their relationship with a person in the home

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to deliver findings on a complaint investigation regarding the above allegation. LPA met with Administrator Dorris Anderson and discussed the purpose of the visit.

Regarding the allegation that a resident was not accorded dignity in their relationship with a person in the home, interviews with the Administrator and resident revealed that the individual in question was a minor family member. In accordance with regulations, minors are not required to undergo fingerprinting or background clearance. The individual was not residing in the home during the investigation, and interviews indicate that during the period in which they did reside at the home, they were not disruptive to residents.

Based on LPAs observations and interviews, the above allegation is Unsubstantiated; meaning that although the allegations 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 was discussed and a copy was provided Administrator Dorris Anderson at the conclusion of the visit.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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