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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 330907269
Report Date: 06/23/2021
Date Signed: 06/23/2021 04:40:19 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/26/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210526100508
FACILITY NAME:PERRIS OASES INCFACILITY NUMBER:
330907269
ADMINISTRATOR:PETERSEN BELENFACILITY TYPE:
740
ADDRESS:21222 DAWES ROADTELEPHONE:
(951) 943-2304
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:15CENSUS: 13DATE:
06/23/2021
UNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Maria PlascenciaTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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9
Facility denied access to Ombudsman.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA met with Administrator, Maria Plascencia, and discussed the purpose of the visit. The investigation consisted of interviews with staff and residents.

LPA interviewed Staff #1 (S1) who denied that facility staff denied the Long-Term Care Ombudsman (LTCO) Staff access to the facility. S1 stated that they are aware of two recent visits from the LTCO staff since the COVID-19 pandemic and on both occasions S1 gave permission for the visit and allowed LTCO staff access inside the facility. S1 also stated that LTCO staff spoke to residents. LPA interviewed Staff #2 (S2) who stated that LTCO staff were not denied access into the facility and that LTCO staff even spoke to residents. LPA interviewed Staff #3 (S3) who stated that they were not employed at the facility during the incident; however, LTCO staff were just inside the facility prior to LPA's arrival on 6/23/2021. Due to conflicting interviewee statements and lack of information to corroborate the allegation, the allegation is unsubstantiated.





Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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 18-AS-20210526100508
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PERRIS OASES INC
FACILITY NUMBER: 330907269
VISIT DATE: 06/23/2021
NARRATIVE
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Based on evidence obtained during today’s visit, LPA has determined that the above allegation is
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 was provided to the Administrator via email.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2