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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 12/03/2025
Date Signed: 12/03/2025 03:53:10 PM

Substantiated


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
10/03/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241003083158
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: 32DATE:
12/03/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shannon Moore - Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Licensee does not ensure that staff have fingerprint clearance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Shannon Moore and explained the reason for the visit.

The investigation consisted of the following: On 10/4/24 LPA Jeon conducted an initial complaint investigation visit, conducted a tour of the facility and requested the pertaining documents. On 12/20/24 LPA Jeon conducted a subsequent investigation visit conducted interviews with 9 staff. On 4/29/25 LPA Jeon conducted a subsequent complaint investigation visit conducted interviews with 9 residents. On 12/1/25 LPA Flores contacted administrator and requested documents. On 12/3/25 LPA Flores conducted a subsequent complaint visit, interviewed 6 staff and 6 residents, and delivered findings.

Regarding allegation: Licensee does not ensure that staff have fingerprint clearance. It is alleged a staff does not have background clearance prior employment. Interviews with residents revealed residents did not know the staff in question. (CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
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 5
Control Number 18-AS-20241003083158
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: 12/03/2025
NARRATIVE
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Interviews with staff revealed 4 out of 9 staff interviewed were aware that the staff in question was present at the facility performing duties for more than a month. Interview conducted by LPA Flores on 12/3/25 revealed maintenance staff are on the floor and perform housekeeping duties as well. Per executive director staff #1(S1) was hired by previous administrator and was not aware the staff did not have a background clearance. Once executive director found out the staff was removed from the facility and background clearance was requested. Document review revealed S1 was hired on 2/16/22 and last day of employment was on 2/8/24. On 2/8/24 LPA Martinez conducted a case management visit in which a review of background clearance was conducted. During that visit it was found S1 did not have a background clearance for which deficiencies and immediate civil penalties were noted.

Based on LPAs interviews which were conducted and records review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview was conducted with Shannon Moore and a copy of this report, LIC 9099D, and appeal rights were provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20241003083158
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/04/2025
Section Cited
CCR
87355(e)(2)
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87355 Criminal Record Clearance (e) All individuals subject to a criminal record review ...(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement is not met as evidence by:
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Executive Director will provide a statement in writing that will ensure to obatain a background clearance for each staff prior employment and will submit to the department by POC due date 12/4/25. Staff #1 has not been working at the faciltiy since 2/8/24.
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Based on document review land interviews icensee did not ensure Staff #1 obtained a background clearance prior employment which poses an immediate risk to the health, safety, or personal rights of the persons in care. *Civil Penalties were noted on 2/8/24. Therefore LPA Flores did not noted any during this visit.*
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
10/03/2024 and conducted by Evaluator Mary G Flores
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20241003083158

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: 32DATE:
12/03/2025
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Shannon Moore - Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility staff are verbally aggressive towards residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegations. LPA met with Shannon Moore and explained the reason for the visit.

The investigation consisted of the following: On 10/4/24 LPA Jeon conducted an initial complaint investigation visit, conducted a tour of the facility and requested the pertaining documents. On 12/20/24 LPA Jeon conducted a subsequent investigation visit conducted interviews with 9 staff. On 4/29/25 LPA Jeon conducted a subsequent complaint investigation visit conducted interviews with 9 residents. On 12/1/25 LPA Flores contacted administrator and requested documents. On 12/3/25 LPA Flores conducted a subsequent complaint visit, interviewed 6 staff and 6 residents, and delivered findings.

The investigation revealed the following: Regarding allegation: Facility staff are verbally aggressive towards residents. It is alleged staff is verbally aggressive with residents.
(CONTINUED ON LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20241003083158
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: 12/03/2025
NARRATIVE
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Interviews conducted with residents revealed 7 out of 9 residents interviewed stated staff are not rude or aggressive. 2 out of 9 residents were not able to answer due to cognitive skills. Interviews with staff revealed 9 out of 9 staff interviewed stated staff have not been observed to be rude to residents. On 12/3/25 LPA Flores conducted interviews with residents who stated staff treat them well and staff have not observed staff being disrespectful towards residents.

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, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Shannon Moore and a copy of this report was provided.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5