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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366427383
Report Date: 01/27/2025
Date Signed: 01/27/2025 03:02:47 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
03/20/2023 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230320102705
FACILITY NAME:ESPINOZA ADULT CARE HOME IFACILITY NUMBER:
366427383
ADMINISTRATOR:LYDIA ESCUTIAFACILITY TYPE:
735
ADDRESS:14232 SAVANA STREETTELEPHONE:
(909) 770-3544
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY:5CENSUS: 4DATE:
01/27/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Amber EspinozaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff handled resident in a rough manner
Staff caused scratches on resident
Staff locked resident inside room
Staff did not properly dispose resident's feces
Staff did not provide resident with clothing
Staff do not provide a comfortable temperature for residents
Staff do not properly sanitize facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit the facility. LPA met with Licensee, Amber Espinoza and discussed the purpose of the visit.

Regarding the allegation, staff handled resident in a rough manner, the Licensee and four (4) staff deny handling residents in a rough manner. LPA was unable to corroborate the allegation with resident #1 (R1), resident #2(R2), resident #3 (R3), and resident #4 (R4) as they are non-verbal.

Regarding the allegation, staff caused scratches on resident, the Licensee and four (4) staff interviewed deny causing scratches any residents. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Regarding the allegation, staff locked resident inside room, the Licensee and four (4) staff deny locking any resident inside a room.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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-20230320102705
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: ESPINOZA ADULT CARE HOME I
FACILITY NUMBER: 366427383
VISIT DATE: 01/27/2025
NARRATIVE
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 LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Regarding the allegation, staff did not properly dispose resident's feces, the Licensee and four (4) staff deny not properly disposing residents' feces. The Licensee maintains a plan for disposing of feces at the facility. LPA's record review of four (4) staff files reveals staff have received infection control training. LPA was unable to corroborate the allegation with R1, R2, R3, and R4 as they are non-verbal.

Regarding the allegation, staff did not provide resident with clothing, the Licensee and four (4) staff deny not providing a resident with clothing. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Regarding the allegation, staff do not provide a comfortable temperature for residents, interviews with the Licensee and four (4) staff reveal that the thermostat is adjusted to comfortable temperatures. LPA observed the facility was at a temperature of 73 degrees Fahrenheit. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Regarding the allegation, staff do not properly sanitize facility, the Licensee and four (4) staff deny not properly sanitizing the facility. LPA observed the facility was maintained clean and there is a sufficient supply of cleaning solutions available for use. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Based on LPA observations, record review and interviews, the allegations mentioned in this report are Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy with appeal rights was provided to the Licensee at the conclusion of the visit.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2