366425610-10-3-2025-56-AS-KCLS-DMVPJL-20251028112143

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 10/03/2025
Date Signed: 10/03/2025 02:18:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/26/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20250926120025

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:	DATE:	10/03/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Caregiver Marinela Orozco/Administrator Dorris Anderson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff did not assist resident with toileting in a timely manner.
Facility staff are unable to communicate effectively with the residents.
Facility staff did not ensure privacy to resident 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 allegations. LPA met with Administrator Dorris Anderson, and discussed the purpose of the visit.

Regarding allegation #1, LPA interviewed six (6) residents. Four (4) of the six (6) residents are independent and do not need assistance with toileting, all 4 residents have denied witnessing or hearing staff not assisting other residents with toileting needs in a timely manner. Two (2) of the six (6) residents interviewed need assistance with toileting needs, 1 of the 2 residents informed LPA staff attend to their toileting needs in a timely manner. R1 informed LPA last week, they were left in bed for over an hour and did not receive assistance with their toileting needs, however R1 stated when they are upset they tend to retaliate with staff.

LPA interviewed an outside party and informed LPA they were on the phone during the alleged incident and R1 was refusing assistance from staff, due to being in a mood.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

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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Control Number 56-AS-20250926120025

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: 10/03/2025

NARRATIVE

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LPA interviewed two (2) staff, both staff informed LPA they attend to residents and their toileting needs in a timely manner. Both staff informed LPA they attended to R1 the day of the alleged incident and R1 got upset and refused assistance.

Regarding allegation #2, LPA interviewed 6 residents, 5 out of 6 residents stated the facility staff can communicate well with residents. 1 of the 6 residents stated S1 understands English, but can not speak it very well. LPA interviewed 2 staff, S1 informed LPA the residents have a routine, not much communication is needed, however they are able to communicate with residents fine. S1 informed LPA R1 can speak Spanish, but if they are in a bad mood they will refuse to speak Spanish. S2 informed LPA S1 cannot speak English fluently, however they are learning and can communicate well with the residents. S2 included the rest of the facility staff are able to speak English and communicate with residents just fine.

Regarding allegation #3, LPA interviewed 6 residents. 5 out of 6 residents informed LPA they have privacy in the facility. 1 of 6 residents did not understand the question. LPA interviewed 2 staff, both have confirmed all residents have privacy while in care, residents are able to close their bedroom doors as well as having privacy while using the bathroom.

Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator Dorris Anderson and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025

LIC9099 (FAS) - (06/04)

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