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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880902
Report Date: 07/21/2026
Date Signed: 07/21/2026 03:13:19 PM

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
04/02/2026 and conducted by Evaluator Ahliah Sharp
COMPLAINT CONTROL NUMBER: 18-AS-20260402112716
FACILITY NAME:BUENA VISTA ASSISTED LIVINGFACILITY NUMBER:
331880902
ADMINISTRATOR:ICAMEN, ROBYNFACILITY TYPE:
740
ADDRESS:1393 S. BUENA VISTA ST.TELEPHONE:
(951) 658-5160
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:74CENSUS: 48DATE:
07/21/2026
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Robyn Icamen, Executive DirectorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff do not ensure Resident’s room is cleaned appropriately
Staff do not ensure Resident’s room is free of pests
Staff do not ensure Resident’s hygiene needs are met
INVESTIGATION FINDINGS:
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On July 21, 2026, Licensing Program Analyst (LPA), Ahliah Sharp, conducted an unannounced visit to the facility to deliver the findings regarding the allegations above. During the investigation, LPA interviewed staff and residents, reviewed facility records, and conducted observations.

Regarding the cleanliness of Resident’s rooms, it was reported that while visiting Resident at the facility, reporting party (RP) became outraged due to the appearance of Resident and their room. RP reported seeing dirty clothes in the corner of the room, and that it ‘smelled like urine’ alleging Resident was not being cared for properly. RP reported seeing ants all over, including some on Resident while in bed and on ceiling. RP stated they had video/pictures to corroborate their allegations. Information obtained from interview with Executive Director (ED), stated that the responsibility for cleaning not only falls on the housekeeping staff, but also on the caregivers in the absence of housekeeping.

Continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ahliah Sharp
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
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 3
Control Number 18-AS-20260402112716
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: BUENA VISTA ASSISTED LIVING
FACILITY NUMBER: 331880902
VISIT DATE: 07/21/2026
NARRATIVE
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Continued from LIC9099C...

Based on the information obtained regarding the allegations and the inability to obtain pertinent evidence, this complaint has been deemed UNSUBSTANTIATED. Unsubstantiated means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted and a copy of the report was provided to ED Robyn Icammen.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ahliah Sharp
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20260402112716
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: BUENA VISTA ASSISTED LIVING
FACILITY NUMBER: 331880902
VISIT DATE: 07/21/2026
NARRATIVE
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Continued from LIC9099

LPA also interviewed additional staff, including housekeeping and it was reported that they all work together to ensure the cleanliness of the facility.
One staff did not think it was ‘clean’ but admitted that everyone views cleanliness differently. Information obtained from interviews with Residents stated they do not have any issues with the cleanliness of their rooms. Some Residents do not want it done by Staff and are ‘particular’ about how they want certain things, but otherwise, when Housekeeping is off, all other Staff are responsible.

On April 6th, April 9, and May 12, 2026, LPA conducted visits to the facility. During each visit, LPA observed the facility to be free of debris and clutter. LPA did not observe any issues regarding cleanliness of the facility that would pose any immediate health or safety concerns or personal rights issues.
Regarding the allegation that staff do not ensure Resident’s rooms are free of pests, ED reported that pest control comes two (2) times each month to service the outside, and in the event a Resident mentions a need inside, that is provided on a case-by-case basis as well. Information obtained from staff stated that they see an occasional pincher bug [Earwig] from time to time but stated that being in a ‘desert’ area, it is not uncommon. Information obtained from interviews with residents stated they had no concerns about pests. LPA conducted an interview with Additional Witness and it was stated that photographs and video of their concerns were taken. LPA requested the evidence on two (2) separate occasions, but the Additional Witness failed to provide any evidence supporting the allegation.

Regarding the allegations pertaining to staff not ensuring Resident’s hygiene needs are being met, information obtained from interviews with ED stated that showering schedules are implemented and tracked through a new digital system. On occasion, Resident might want to refuse showers, but it is logged and Staff will work hard to encourage Resident to shower at a later time or date. Information obtained from interviews with Staff corroborated the reports from ED. Information obtained from residents and reviewing records, also corroborated the reports from ED.

Continued on LIC9099C...
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ahliah Sharp
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3