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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881153
Report Date: 04/06/2026
Date Signed: 04/06/2026 03:05:59 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
10/31/2023 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231031091403
FACILITY NAME:WESTWARD RESIDENTIAL CAREFACILITY NUMBER:
331881153
ADMINISTRATOR:YBANEZ, ROSYFACILITY TYPE:
735
ADDRESS:156 FOX TROTTER PLACETELEPHONE:
(951) 665-3767
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY:4CENSUS: 4DATE:
04/06/2026
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Adriana Mejia - CaregiverTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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Staff did not provide medication to client in a timely manner

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Caregiver Adriana Mejia and explained the purpose of today's visit, shortly after Administrator Rosey Ybanez arrived to assist with visit.

The investigation consisted of the following:
LPA interviewed 2 Staff (S1-S2), 2 Clients (C2-C3) and 1 witness (W1), C1 is no longer a client at facility, therefore, interview with C1 was no conducted. LPA conducted medication review for 3 Clients, inspected food supply, and obtained copies of the following documents within C1's file: C1’s Medication Administration Record (MAR) from September 2023-October 2023, Seizure Observation Log from 4/13/23-10/8/23, Daily Ongoing Notes from 10/12/23 – 10/29/23, Fluid Intake Chart from 10/22/23-10/27/23 .

(Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
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 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
10/31/2023 and conducted by Evaluator Tena Herrera
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231031091403

FACILITY NAME:WESTWARD RESIDENTIAL CAREFACILITY NUMBER:
331881153
ADMINISTRATOR:YBANEZ, ROSYFACILITY TYPE:
735
ADDRESS:156 FOX TROTTER PLACETELEPHONE:
(951) 665-3767
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY:4CENSUS: 4DATE:
04/06/2026
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Adriana Mejia - CaregiverTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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9
Staff is not following client’s doctor's order
Staff did not following client’s dietary needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced complaint visit to investigate the above allegations. LPA met with Caregiver Adriana Mejia and explained the purpose of today's visit, shortly after Administrator Rosey Ybanez arrived to assist with visit.

The investigation consisted of the following:
LPA interviewed 2 Staff (S1-S2), 2 Clients (C2-C3) and 1 witness (W1), C1 is no longer a client at facility, therefore, interview with C1 was no conducted. LPA conducted medication review for 3 Clients, inspected food supply, and obtained copies of the following documents within C1's file: C1’s Medication Administration Record (MAR) from September 2023-October 2023, Seizure Observation Log from 4/13/23-10/8/23, Daily Ongoing Notes from 10/12/23 – 10/29/23, Fluid Intake Chart from 10/22/23-10/27/23 .

(Continued on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20231031091403
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: WESTWARD RESIDENTIAL CARE
FACILITY NUMBER: 331881153
VISIT DATE: 04/06/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff is not following client’s doctor's order.


It is alleged that medication is not being given to C1 per doctors’ orders which would help decrease C1’s seizures. LPA obtained copies of C1’s Seizure Observation Log from 4/13/23-10/8/23 which averaged 2 seizures a month, log did not indicate higher amount of seizure that would suggest the above allegation to be correct. LPA obtained copies of Daily Ongoing Notes from 10/12/23 – 10/29/23 that documented C1 was taking medication daily. LPA interviewed 2 clients and both denied the allegation and stated they feel the staff follow doctors orders including taking them to the doctors when they are not feeling well and taking them to their routinely scheduled appointments.

Allegation: Staff did not follow client’s dietary needs.
It is alleged that staff are not providing C1 with a proper diet. LPA interviewed 2 clients and each denied the allegation stating that facility maintains their dietary needs and are provided with snack and 3 meals a day which they can get second servings if needed. LPA obtained copies of C1's Fluid Intake Chart from 10/22/23-10/27/23 that documented how much fluids C1 was consuming. LPA reviewed facility food supply and although it was low, there appeared to be the required 7-day nonperishable and 2-day perishable food supply, administrator stated that they are planning to do a grocery run for facility tomorrow 4/7/26 which is the regularly scheduled restock day, to ensure there is enough food supply at all times in the facility.

Based on statements and interviews conducted with staff and clients, review of C1's files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20231031091403
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: WESTWARD RESIDENTIAL CARE
FACILITY NUMBER: 331881153
VISIT DATE: 04/06/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Staff did not provide medication to client in a timely manner.
It is alleged that staff is not providing C1 with medication in a timely manner. LPA conducted medication review for 3 Clients with no issues observed. LPA interviewed 2 clients and each denied the allegation, C2 stated they do not take any medications and C3 stated the staff make sure medication is given at the same time every day. LPA obtained copies of C1’s MAR from September 2023-October 2023, there was no documentation of medication errors or medication being administered late. LPA interviewed 2 staff and both confirm that this was investigated by Regional Center and there was a corrective action plan issued along with a required training on medication to be conducted, S1 confirmed that in 2023 there was a staff that was found not to be giving C1 medication at the required time. Administrator stated they will provide LPA with the outcome of the investigation, the Corrective Action Plan that was issued and the required training that was conducted.

Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D. Exit interview held, and a copy of this report and appeal rights were provided.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20231031091403
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: WESTWARD RESIDENTIAL CARE
FACILITY NUMBER: 331881153
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
04/07/2026
Section Cited
CCR
80075(b)
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80075 Health Related Services (b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidence by:
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Administrator to send LPA a copy of the Corrective Action Plan that was issued for this error and a copy of the medication training log with participant names by POC due date.
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During interviews both S1 and S2 confirmed that in 2023 Regional Center investigated this allegation and it was found that staff were not administering C1 with their medication on time. S1 confirmed there was a staff that was not giving C1 their medication as required and a training was conducted for all staff to ensure they are administering medication to the clients as prescribed .
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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: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5