366427383-5-27-2025-56-AS-NBRN-DLNN5H-20250919100932

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366427383
Report Date: 05/27/2025
Date Signed: 05/27/2025 02:44:04 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
04/29/2025 and conducted by Evaluator Becky Mann

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20250429135038

FACILITY NAME:	ESPINOZA ADULT CARE HOME I		FACILITY NUMBER:	366427383
ADMINISTRATOR:	LYDIA ESCUTIA		FACILITY TYPE:	735
ADDRESS:	14232 SAVANA STREET		TELEPHONE:	(909) 770-3544
CITY:	ADELANTO	STATE: CA	ZIP CODE:	92301
CAPACITY:	5	CENSUS: 4	DATE:	05/27/2025
		UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Lydia Escutia, Administrator		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff physically abused residents
Staff verbally abused residents
Staff inappropriately punished residents
Staff did not ensure facility was adequately cleaned
Staff did not assist resident with personal hygiene care needs
Staff did not comply with reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Lydia Escutia, Administrator and explained the purpose of today's visit. The investigation consisted of LPA observations, pertinent document reviews, and interviews with staff and residents.

The allegation that staff physically abused residents. Seven (7) staff interviewed denied physically abusing the residents. 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.

The allegation that staff verbally abused residents. Seven (7) staff interviewed denied verbally abusing the residents. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025

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-20250429135038

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: ESPINOZA ADULT CARE HOME I	FACILITY NUMBER: 366427383
	VISIT DATE: 05/27/2025

NARRATIVE

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The allegation that staff inappropriately punished residents. Seven (7) staff interviewed denied inappropriately punishing the residents. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

The allegation that staff did not ensure facility was adequately cleaned. Seven (7) staff interviewed denied not ensuring the facility was adequately cleaned. 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.

The allegation that staff did not assist resident with personal hygiene care needs. Seven (7) staff interviewed stated that they do assist resident with personal hygiene care needs. Based on LPA observations, residents are well groomed, and their clothes are washed and clean. LPA was unable to corroborate the allegation with R1, R2, R3 and R4 as they are non-verbal.

The allegation that staff did not comply with reporting requirements. During the records review, LPA observed that all staff have completed the reporting requirements training and have reported incidents to the Community Care Licensing (CCL). LPA observed that the facility has the CCL complaint poster posted in the common area accessible to residents, staff and visitors. Interviews with staff, revealed that incidents are reported immediately to the lead staff and documented.

Based on evidence obtained during this investigation, the allegations above 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 did or did not occur.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Lydia Escutia, Administrator at the conclusion of the visit

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:	DATE: 05/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/27/2025

LIC9099 (FAS) - (06/04)

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