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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 04/24/2025
Date Signed: 04/24/2025 02:43:20 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
04/16/2025 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250416103400
FACILITY NAME:DESERT HILLS MEMORY CARE CENTERFACILITY NUMBER:
331880722
ADMINISTRATOR:HUDSON, CHANTELLEFACILITY TYPE:
740
ADDRESS:25818 COLUMBIA STTELEPHONE:
(951) 652-1837
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:58CENSUS: 33DATE:
04/24/2025
UNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:Lavina Dubose, Memory Care DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not prevent an unknown individual access to the facility resulting in a resident being physically attacked while in care.
INVESTIGATION FINDINGS:
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On 04/24/25 Licensing Program Analysts (LPA)s Abdoualye Zerbo and Javina George made an unannounced visit to the facility to commence a complaint investigation for the allegation noted above. LPA met with Lavina Dubose, Memory Care Director and explained the purpose of the visit and the elements of the allegation. The allegation was investigated, and the investigation consisted of observations, interviews and record review.

On 04/16/25 Community Care Licensing received a complaint alleging staff did not prevent an unknown individual access to the facility resulting in a resident being physically attacked while in care. Per interview with Executive Director Shannon Moore, there has not been any incidences as alleged to have occurred with individuals outside of the facility being granted access to the facility and attacking any residents in care. Per a file review the facility is a secured perimeter and requires a door code to be granted entry to each buidling on the premises. Interview conducted with Resident #1 (R1) revealed there was an incident with Resident #2 (R2) where they were walking down the wrong hallway and R1 told them that it was not their room and R2
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
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 18-AS-20250416103400
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DESERT HILLS MEMORY CARE CENTER
FACILITY NUMBER: 331880722
VISIT DATE: 04/24/2025
NARRATIVE
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proceeded to hit R1, causing R1 to fall to the ground. Per a record review of Unusual Incident/Injury report submitted to the department revealed that on 04/15/25 there was an incident involving R1 and R2 being involved in an incident where R1 was sent out due to a lump on the back of their head, and law enforcement being contacted. In addition regarding R2 due to their increased agitation, R2 followed up with their Primary Care Physician and the facility implemented and alert charting.

Based on interviews and record review the allegation of staff did not prevent an unknown individual access to the facility resulting in a resident being physically attacked while in care is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report, 9099C, LIC811-Confidential names list was reviewed and provided to Lavina Dubose, Memory Care.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 04/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2