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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 12/02/2024
Date Signed: 12/02/2024 03:48:17 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
11/27/2024 and conducted by Evaluator Sarina Ramirez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241127151903
FACILITY NAME:EXCELCAREFACILITY NUMBER:
366425610
ADMINISTRATOR:ANDERSON, DORRISFACILITY TYPE:
740
ADDRESS:11400 POPLAR STREETTELEPHONE:
(909) 796-4553
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:10CENSUS: 10DATE:
12/02/2024
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Administrator Doris AndersonTIME COMPLETED:
03:55 PM
ALLEGATION(S):
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Staff did not ensure facility is kept at a comfortable temperature for residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPA met with Administrator Doris Anderson and discussed the purpose of the visit.

Regarding allegation above. LPA conducted interviews with staff and residents, toured, and observed the facility. LPA observed the facility thermostat to read 69 and 70 degrees F.

LPA Ramirez conducted 6 resident interviews, 2 out of 6 residents informed LPA the facility is cold. 2 out of 6 residents informed LPA the facility is kept at a good temperature, 2 out of 6 residents informed LPA the facility is cold sometimes, however they notify the staff when it's too cold and the temperature is adjusted. LPA was also informed the heater is turned on at night while residents sleep.

LPA conducted 3 staff interviews, 2 out of the 3 staff informed LPA the facility is cold sometimes, however the
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
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-20241127151903
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: EXCELCARE
FACILITY NUMBER: 366425610
VISIT DATE: 12/02/2024
NARRATIVE
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temperature is kept within the regulation requirements. Staff informed LPA if concerns about the temperature are brought to attention they will notify the Administrator; staff also informed LPA the only person to adjust the temperature is the Administrator. 1 out of the 3 staff informed LPA the thermostat is turned off in the morning to ventilate the facility, however it does not remain turned off all day, with their permission staff is able to adjust the temperature to accommodate all residents in care.

Based on LPAs observations and interviews, the above allegation is Unsubstantiated. A finding that complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and this report was discussed and provided to Administrator Doris Anderson

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2