335530266-7-2-2026-56-AS-NBRN-DW9VC4-20260723161831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 07/02/2026
Date Signed: 07/02/2026 03:53:53 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
06/23/2026 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20260623103626

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: 144	DATE:	07/02/2026
		UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Executive Director Cristina Ceballos		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff are not properly supervising residents

INVESTIGATION FINDINGS:

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

It is alleged staff are not supervising residents. Interviews conducted reveal Resident (R1) has been experiencing agitated behavior. R1 was pushing Resident #2 (R2) in their wheelchair when R1 suddenly became agitated and tipped R2 out of their wheelchair.

LPA attempted to interview R2 regarding the incident, however R2 could not remember what happened. R2 with two (2) other residents state there’s enough staff and supervision. LPA also conducted three (3) additional resident interviews, two (2) have stated they don’t know if there’s enough staff and supervision while one (1) stated there is not enough staff and supervision.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

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-20260623103626

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: 07/02/2026

NARRATIVE

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LPA conducted interviews with three (3) staff, all whom state they are supervising residents; however Two (2) have stated incidents may happen the second their backs are turned rather than lack of supervision.

Based on observation, interviews, and pertinent documents the allegation is unsubstantiated. An Unsubstantiated complaint means, that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

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: 07/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2026

LIC9099 (FAS) - (06/04)

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