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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881582
Report Date: 04/28/2026
Date Signed: 04/28/2026 03:27:04 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
04/20/2026 and conducted by Evaluator Janette Romero
COMPLAINT CONTROL NUMBER: 18-AS-20260420151242
FACILITY NAME:MURRIETA GARDENSFACILITY NUMBER:
331881582
ADMINISTRATOR:KAVENAUGH, BRITTANYFACILITY TYPE:
740
ADDRESS:24200 MONROE AVETELEPHONE:
(951) 600-7676
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:126CENSUS: 41DATE:
04/28/2026
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator Kylee CarterTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility staff mismanaged Resident 1's medication
INVESTIGATION FINDINGS:
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On 04/28/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to investigate the allegation listed above. LPA met with Administrator Kylee Carter who was informed of the purpose of the visit.

LPA toured the facility with Administrator Carter, conducted interviews, and obtained copies of pertinent documentation. Regarding the allegation, “Facility staff mismanaged Resident 1's medication” it was reported that on 01/16/2026, Resident 1 (R1) received a 30-day refill supply of Medication 1 (M1) to be dispensed every night at bedtime which required to be refilled again on or before 02/16/2026. It was alleged that the facility staff did not notify R1’s responsible person that M1 had depleted which resulted in R1 not receiving M1 until mid March of 2026. It was further alleged that on 01/20/2026, R1 received a 90-day supply of Medication 2 (M2) to be administered every evening, which required to be refilled on or by 04/20/2026. However, it was reported that a physical audit of R1’s medications was conducted on 04/18/2026 and revealed there were approximately 20 tablets leftover of M2 in the medication bottle.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
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-20260420151242
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: MURRIETA GARDENS
FACILITY NUMBER: 331881582
VISIT DATE: 04/28/2026
NARRATIVE
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Administrator Carter was interviewed and reported that medication technicians/wellness director are trained and required to contact a resident’s responsible person approximately 7-14 days in advance to request a medication refill prior to a medication depleting to allow sufficient time for the refill to be delivered to the facility promptly. Administrator was unable to locate any record to prove that R1’s responsible person was contacted to request a refill for M1 on or around February of 2026.

LPA reviewed R1’s physician’s report dated 12/10/2024 documenting R1 exhibits memory loss and requires medication management. LPA reviewed R1’s Resident Service Plan listing their date of admission as 02/27/2025 also noting R1 requires medication management.



LPA reviewed R1’s physician’s order for M1 dated 12/15/2025 and M2 dated 01/20/2026. LPA reviewed R1’s Centrally Stored Medication and Destruction Record (CSMDR) documenting the facility received 30 tablets of M1 on 01/13/2026 followed by 90 tablets on 03/13/2026. However, the CSMDR does not note the facility received a refill for M1 on or before 02/12/2026. The CSDMR also notes the facility received 90 tablets of R1’s M2 on 01/20/2026.

LPA reviewed R1’s MAR for February of 2026 which documents R1 received M1 and M2 as prescribed during the entire month. LPA also reviewed R1’s MAR for March of 2026 and noted M1 and M2 have 14 dates where the staff initials are circled in the section that is used to document whether the medications were administered. Administrator Carter explained that circled staff initials in the MAR indicate the medication was not given due to reasons such as the resident being out of the facility or the facility awaiting medication delivery. LPA reviewed the R1’s MAR exception which documents the reason for not dispensing the medication on the 14 dates as, “Awaiting Delivery”. Administrator Carter reported, “Awaiting Delivery” refers to facility staff waiting for medications to be delivered to the facility. However, the CSMDR notes the facility received 90 tablets of R1’s M2 on 01/20/2026 which did not require to be refilled until 04/20/2026. LPA also reviewed a photograph dated 04/18/2026 of R1’s M2 that contained at least 20 tablets in the medication bottle. There is no record or report that R1 received physician orders to discontinue M1 or M2 during the time the MAR for March of 2026 notes R1 did not receive the medication.

Based on interviews conducted and records reviewed, 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, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report, Confidential Names list (LIC 811) and Appeal Rights were reviewed and provided to Administrator Carter.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20260420151242
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: MURRIETA GARDENS
FACILITY NUMBER: 331881582
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2026
Section Cited
CCR
87465(a)(4)
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(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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Administrator reported she will develop a "Medication Refill Request Log" to ensure medication refills are requested timely. Administrator reported she will also conduct an in-service staff training regarding proper medication management and documentation. POC to be emailed to LPA by cob on 05/08/2026.
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Based on interviews and records conducted, the facility mismanaged R1's medications. This poses a potential health risk to residents in care.
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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: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3