366425610-6-19-2026-56-AS-KCLS-DVDQ6V-20260625115410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 06/19/2026
Date Signed: 06/19/2026 02:45:58 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
12/04/2025 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20251204115820

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:	06/19/2026
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Caregiver Rose Viernes		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff do not ensure a resident is being properly fed
Staff do not ensure a resident consumed an appropriate amount of liquid
Staff served a resident spoiled food
Staff are not abiding to the admission agreement
Staff do not timely address a resident's change in medical condition
Staff do not meet a resident's bathing needs
Staff do not provide a comfortable temperature for a resident

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 allegations. LPA met with Caregiver Rose Viernes and discussed the purpose of the visit.

Regarding Allegation #1: During the lunch observation, LPA noted that the resident’s meal appeared to be of good quality. LPA also observed an adequate supply of perishable and non perishable food items for residents in care. LPA interviewed two (2) staff members, both of whom stated that residents are being properly fed. LPA additionally interviewed four (4) residents, all of whom confirmed they are properly fed.

Regarding Allegation #2: LPA observed a cup of water in each resident’s bedroom. LPA interviewed two (2) staff members, both stating they ensure residents are drinking enough water. The Administrator also stated that water is always available in residents’ rooms. LPA interviewed five (5) residents, all of whom reported receiving an adequate amount of liquids.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

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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Control Number 56-AS-20251204115820

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: 06/19/2026

NARRATIVE

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Regarding Allegation #3: LPA did not observe any spoiled food in the facility. LPA interviewed two (2) staff members, both of whom stated they do not serve spoiled food to residents. Administrator states some residents have refrigerators in their rooms, maybe some food items may have spoiled without their knowledge. LPA also interviewed four (4) residents, all of whom stated they are not served spoiled food.

Regarding Allegation #4: LPA interviewed two (2) staff members, both stating they are adhering to the admission agreement. The administrator also stated that they are not responsible for determining rent increases and that all payment adjustments are handled directly through InnovAge. LPA interviewed three (3) residents; two (2) stated staff follow the admission agreement, while the remaining resident was unsure.

Regarding Allegation #5: LPA interviewed two (2) staff members, both stating they address changes in a resident’s condition in a timely manner. The Administrator stated that if a resident’s condition worsens, responsible parties, families, and social workers are notified immediately. LPA interviewed three (3) residents; two (2) reported that staff respond to changes in their condition in a timely manner, while the third did not understand the question.

Regarding Allegation #6: LPA interviewed two (2) staff members who both stated that residents’ bathing needs are being met, although residents occasionally refuse showers. LPA interviewed four (4) residents, all of whom stated their bathing needs are being met.

Regarding Allegation #7: LPA observed the facility to be at a comfortable temperature, with the thermostat reading 70 degrees Fahrenheit. LPA interviewed two (2) staff members, both stating the facility is maintained at a comfortable temperature. LPA also interviewed five (5) residents, all of whom confirmed the temperature is comfortable.

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that 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 where this report was discussed and a copy was provided to Caregiver Rose Viernes at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2026

LIC9099 (FAS) - (06/04)

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