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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530171
Report Date: 11/05/2025
Date Signed: 11/05/2025 01:46:30 PM

Unsubstantiated


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
10/17/2025 and conducted by Evaluator Hannah Rodgers
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251017143416
FACILITY NAME:WILDOMAR SENIOR ASSISTED LIVINGFACILITY NUMBER:
335530171
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:32365 SOUTH PASADENA STTELEPHONE:
(323) 902-6000
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:200CENSUS: 111DATE:
11/05/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Executive Director Karen Roper and Assistant Executive Director Theresa Gamez TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Neglect/Lack of Supervision resulted in resident's hospitalization
Licensee did not ensure resident received wound care
Facility staff are not allowing resident to use wheelchair
Facility staff are not allowing resident to leave bedroom
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to deliver findings regarding the above complaint allegations. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper and Assistant Executive Director Theresa Gamez.

On October 17, 2025, it was alleged that neglect/lack of supervision resulted in resident’s hospitalization, licensee did not ensure resident received wound care, facility staff are not allowing resident to use wheelchair, and facility staff are not allowing resident to leave bedroom. The Department’s investigation consisted of an unannounced facility visit, records review, and staff, resident, and outside source interviews.
According to the allegations received, Resident #1 (R1) was hospitalized due to staff neglect and R1 did not receive wound care on October 15, 2025, as was planned to. It was alleged that R1 was confined to their bedroom and not allowed to leave and that facility staff took away their wheelchair.

[Continued on LIC9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
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 2
Control Number 56-AS-20251017143416
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: WILDOMAR SENIOR ASSISTED LIVING
FACILITY NUMBER: 335530171
VISIT DATE: 11/05/2025
NARRATIVE
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Review of R1’s medical records revealed that on October 13, 2025, R1 had an emergency room visit due to inflammation of their wound. Review of facility records revealed that the Executive Director of the facility self-reported R1’s emergency room visit to the Department. Per record review and interviews, R1 was on home health services for wound care and on October 13, 2025, R1 was receiving wound care from the home health nurse when R1 had complaints of pain. R1 was then sent out to the hospital via emergency services. Records review and internal and external source interviews did not reveal that neglect/lack of supervision resulted in R1’s hospitalization, as R1 was on home health services for wound care and R1 returned back to the facility from the emergency department on the same day.

Review of R1’s medical records revealed that R1 was home health services for wound care and outside source interviews confirmed that R1 was being seen by a home health nurse three times a week for wound care. Review of R1’s home health notes revealed that R1 was seen by the home health nurse on October 16, 2025. Outside source interviews and records review did not reveal that R1 was scheduled for wound care on October 15, 2025. Also, interviews with internal and external sources did not reveal that R1 was confined to their bedroom nor did the facility staff take away R1’s wheelchair.

Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude that neglect/lack of supervision resulted in resident’s hospitalization, licensee did not ensure resident received wound care, facility staff are not allowing resident to use wheelchair, and facility staff are not allowing resident to leave bedroom. Based on the foregoing, the allegations are unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper and Assistant Executive Director Theresa Gamez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:

DATE: 11/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2