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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530121
Report Date: 12/27/2024
Date Signed: 12/27/2024 12:08:51 PM

Document Has Been Signed on 12/27/2024 12:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:EAGLE CREST ASSISTED LIVING HOMEFACILITY NUMBER:
335530121
ADMINISTRATOR/
DIRECTOR:		WILSON, LATONIAFACILITY TYPE:
740
ADDRESS:35111 TAVEL STTELEPHONE:
(951) 484-5960
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY: 6CENSUS: 4DATE:
12/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Licensee/Administrator Latonia Wilson TIME VISIT/
INSPECTION COMPLETED:
12:15 PM
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On 12/27/2024 at 09:00 AM, Licensing Program Analyst (LPA), Melody Brown made an unannounced visit to the facility for a case management visit and met with a staff. LPA Brown explained the purpose of the visit to Staff #2- (S2). Licensee/Administrator Latonia Wilson was contacted and arrived during the visit. LPA Brown explained the purpose of the visit to Licensee/Administrator Wilson.

This case management visit was made regarding an incident that occurred at the facility and the facility submitted Report of Suspected Dependent Adult/Elder Abuse (SOC341) to Riverside County Ombudsman and Community Care Licensing Division (CCLD) on 12/26/2024 where it was alleged that Staff #3 (S3) stole Resident #1 (R1) checks and wrote two (2) checks that were cashed and addressed to S3 with the total amount of $4,370.00 and R1 does not have knowledge or authorized the reported transactions. In addition, it was also alleged that S3 stole Resident #2 (R2) checks and wrote a check addressed to S3 family member with an amount of $5,000 that was cashed and R2 does not have knowledge and R2 did not give permission to S3 for the reported transaction.

The investigation was conducted by LPA Melody Brown. The investigation consisted of observations, interviews with staff members and residents, and record review. During an interview with R1 and R2, the information regarding their accounts were corroborated. Licensee/Administrator provided LPA Brown police report number for R1 and informed LPA Brown that the R2's family will file a police report today, 12/27/2024 and will provide LPA Brown the information once it's available. LPA Brown collected pertinent residents file information, relevant responsible party, and family member contact information as well as staffs and resident roster information.

Licensee/Administrator Wilson was advised that additional information including interviews, calls and record review may be needed to complete CCLD investigation at a later date.

An exit interview was conducted where this report, LIC809 was discussed and provided to Licensee/Administrator Latonia Wilson.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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