<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 11/13/2025
Date Signed: 11/13/2025 02:52:53 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
11/08/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20251108205259
FACILITY NAME:LAKES, THEFACILITY NUMBER:
335530266
ADMINISTRATOR:MATSUSHITA, LORIFACILITY TYPE:
740
ADDRESS:5801 SUN LAKES BLVDTELEPHONE:
(915) 845-2220
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:276CENSUS: 137DATE:
11/13/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director Cristina CeballosTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not ensure pathways are free of obstruction.
Staff does not ensure facility is free of mold.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarina Ramirez conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPA met with Executive Director Cristina Ceballos, and discussed the purpose of the visit.

Regarding allegation #1: It is alleged that a charging vehicle obstructs the outside passageway. During Licensing Program Analyst’s (LPA’s) visit, no such vehicle was observed. The designated charging area used on Mondays, Wednesdays, and Fridays is located in the driveway and does not interfere with pedestrian access. LPA conducted a thorough tour of both the interior and exterior of the facility and observed no obstructions in any passageways.

LPA interviewed three (3) staff members, all of whom confirmed that they routinely ensure all pathways remain clear. Two staff members noted that inside the facility while residents occasionally leave trash outside their doors, staff will promptly remove it and confirmed that such items do not obstruct resident passageways.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
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-20251108205259
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: LAKES, THE
FACILITY NUMBER: 335530266
VISIT DATE: 11/13/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA interviewed seven (7) residents, five (5) of the 7 residents stated that the passageways are free of obstruction. Two (2) of the 7 residents stated every once in a while, a car is parked in the charging area which they say obstructs the outside pathway.

Regarding allegation #2, LPA interviewed seven (7) residents regarding the allegation. Six residents stated that staff consistently maintain the facility to ensure it remains free of mold. One resident (R1) reported that mold was present inside their toilet tank. During the facility tour, LPA inspected R1’s toilet by removing the tank lid and did not observe any mold. According to R1, the issue was reported to staff, and the toilet tank was subsequently cleaned. Staff member S4 confirmed that the tank was assessed when R1 raised the concern. Upon inspection, S4 identified the substance as slimy buildup rather than mold, which was cleaned the following day by designated staff. LPA also interviewed three (3) staff members, all of whom affirmed that the facility is free of mold and stated they have neither observed nor received reports of mold within the premises.

Based on LPA’s observations, staff and resident interviews, and relevant documentation, the allegations are determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegations may be valid or could have occurred, there is insufficient evidence to support that the alleged violation did or did not happen.

An exit interview was conducted with Executive Director Cristina Ceballos, and a copy of this report was provided at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2