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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530121
Report Date: 07/22/2025
Date Signed: 07/22/2025 04:43:04 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
07/14/2025 and conducted by Evaluator Raquel Hernandez
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250714135727
FACILITY NAME:EAGLE CREST ASSISTED LIVING HOMEFACILITY NUMBER:
335530121
ADMINISTRATOR:WILSON, LATONIAFACILITY TYPE:
740
ADDRESS:35111 TAVEL STTELEPHONE:
(951) 484-5960
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:6CENSUS: 0DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:N/ATIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Licensee is not providing a refund to resident as required.
Facility is in financial distress.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Raquel Hernandez conducted an unnannounced visit for the purpose to deliver findings on the allegations listed above. LPA Hernandez was unable to meet with Administrator Latonia Wilson due to personal reasons. LPA called Administrator Latonia Wilson and explained the purpose of today's visit.

For the allegation, Licensee is not providing a refund to resident as required.

LPA Hernandez spoke with Administrator Latonia Wilson who stated a refund has not been provided to resident's representative at this time. During this time Administrator Latonia Wilson stated they are unable to provide a refund.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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 3
Control Number 56-AS-20250714135727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: EAGLE CREST ASSISTED LIVING HOME
FACILITY NUMBER: 335530121
VISIT DATE: 07/22/2025
NARRATIVE
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For the allegation, Facility is in financial distress.

Administrator Latonia Wilson reported the facility is in financial distress and there are no residents or staff that are living or working at the facility.

Based on observations, interviews, the allegations are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

During today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report LIC9099, LIC9099C and LIC9099D were discussed and were unable to provide Administrator Latonia Wilson copy of reports. LPA Hernandez will send copy of reports via certified mail along with a copy of appeal rights to Administrator Latonia Wilson.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 56-AS-20250714135727
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: EAGLE CREST ASSISTED LIVING HOME
FACILITY NUMBER: 335530121
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/29/2025
Section Cited
CCR
87507(5)(A)
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87507 Admission Agreements (5) Refund Conditions: (A) Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death...
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Licensee stated to surrender facility license and plans on calling licensing department to discuss closure plan on 07/28/2025.
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Based on interview, the licensee did not comply with the section cited above by not ensuring a refund was provided to Resident #1 (R1) responsible person, which poses a potential health, saftey or personal rights risk to persons in care.
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Type B
07/29/2025
Section Cited
CCR
87213
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87213 Finances: The licensee shall have a financial plan that conforms to the requirements of Section 87155, Application for License, and that assures sufficient resources to meet operating costs for care of residents; shall maintain adequate financial records...
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Licensee stated to surrender facility license and plans on calling licensing department to discuss closure plan on 07/28/2025.
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Based on interview, the licensee did not comply with the section cited above by not ensuring facility remained out of financial distress, which poses potential health, saftey or personal rights risk to persons 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: Efren Malagon
LICENSING EVALUATOR NAME: Raquel Hernandez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3