335530266-1-22-2026-56-AS-KCLS-DWENDG-20260728102219

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 01/22/2026
Date Signed: 01/22/2026 01:16:40 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
01/13/2026 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20260113133659

FACILITY NAME:	LAKES, THE		FACILITY NUMBER:	335530266
ADMINISTRATOR:	MATSUSHITA, LORI		FACILITY TYPE:	740
ADDRESS:	5801 SUN LAKES BLVD		TELEPHONE:	(915) 845-2220
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	276	CENSUS: 132	DATE:	01/22/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Executive Director Cristina Ceballos		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegation. LPAs met with Executive Director Cristina Ceballos, and discussed the purpose of the visit.

It has been alleged that staff did not adequately safeguard R1’s personal belongings, specifically a substantial amount of money. Upon review of R1’s personnel file, there is no documentation of this money on the Resident Personal Property and Valuables Form (LIC 621). During an interview with the Executive Director, it was noted that R1 has been observed carrying a small box in and out of the facility on multiple occasions. Staff reported they were unaware that R1 possessed any items of significant value beyond those listed on the LIC 621. LPAs were unable to interview R1 due to no longer living at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 01/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20260113133659

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: 01/22/2026

NARRATIVE

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LPAs interviewed seven (7) staff, all whom stated they have not seen nor taken items from resident’s rooms. Four (4) of the seven (7) staff informed LPAs they do not open cabinets in residents rooms, they only clean counter tops and never touch personal belongings.

LPAs interviewed five (5) residents, all whom stated they have not had anything gone missing in their rooms.

Based on LPA’s staff and resident interviews, and relevant documentation, the allegation is determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegation 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: 01/22/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/22/2026

LIC9099 (FAS) - (06/04)

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