331880722-12-4-2025-18-AS-RORN-DPERKQ-20251216120556

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 12/04/2025
Date Signed: 12/04/2025 11:10:00 AM

Unsubstantiated

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
10/08/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20241008131029

FACILITY NAME:	DESERT HILLS MEMORY CARE CENTER		FACILITY NUMBER:	331880722
ADMINISTRATOR:	HUDSON, CHANTELLE		FACILITY TYPE:	740
ADDRESS:	25818 COLUMBIA ST		TELEPHONE:	(951) 652-1837
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	58	CENSUS: 32	DATE:	12/04/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shannon Moore - Executive Director		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff physically assaulted resident
Staff did not report incident between residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent 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 10/14/24 LPA Seon conducted an initial complaint investigation visit interviewed 6 residents and 2 staff. On 10/15/24 LPA Seon interviewed a staff over the phone. On 12/20/25 LPA Seon conducted a subsequent complaint investigation visit, interviewed 2 residents and 5 staff. On 12/1/25 LPA Flores contacted administrator and requested pertaining documents. On 12/3/25 LPA Flores interviewed 6 residents. On 12/4/25 LPA Flores delivered findings.

The investigation revealed the following: Regarding allegation: Staff physically assaulted resident. It is alleged a staff member drag resident #1(R1).
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

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 18-AS-20241008131029

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: 12/04/2025

NARRATIVE

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Interviews conducted with 7 staff revealed staff have not been aggressive with residents while in care. Interviews with residents revealed staff treat them with respect and have not hurt any residents. Interviews with staff revealed staff have not observed staff mistreating residents in any way. Staff treat residents with respect. Resident rights training was provided on 7/19/24 to staff.

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.

Regarding allegation: Staff did not report an incident between residents. It is alleged incident between R1 and resident #2(R2) was not reported to the proper agencies. Interviews with residents revealed 4 out of 6 residents have not observed incidents between residents. 2 out of 6 residents were not able to respond due to cognitive skills. Interviews with staff revealed staff intervened when residents begin to show behaviors by redirecting the residents into an activity. If incidents between residents are observed the caregiving staff reported to the nurse and the nurse follows protocol to report to the proper agencies and responsible party. Document review revealed on 11/1/24 an incident report was submitted to the department to report an incident between two clients.

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: 12/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025

LIC9099 (FAS) - (06/04)

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