335530266-4-10-2026-56-AS-NBRN-DXGRYT-20260831132652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 04/10/2026
Date Signed: 04/10/2026 02:40:16 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
02/11/2026 and conducted by Evaluator Sarina Ramirez

COMPLAINT CONTROL NUMBER: 56-AS-20260211131614

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: 127	DATE:	04/10/2026
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Executive Director Cristina Ceballos		TIME COMPLETED:	02:50 PM

ALLEGATION(S):

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Staff did not prevent a resident from sustaining multiple falls while in care.
Staff did not report an incident to resident's responsible party.

INVESTIGATION FINDINGS:

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

Regarding Allegation #1, it was alleged that staff did not prevent a resident (R1) from sustaining multiple falls while in care. Interviews conducted with eight (8) staff members confirm that staff consistently take measures to prevent resident falls. Four (4) of the eight (8) staff reported that R1 has a tendency to fall frequently; however, they also noted that R1 often does not use their call pendant when needing assistance. One (1) staff member stated they have reminded R1 multiple times to request assistance, but R1 continues to attempt ambulation independently, which has resulted in falls. LPA advised Executive Director that R1 should be reassessed due to the frequency of their falls.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

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-20260211131614

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: 04/10/2026

NARRATIVE

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R1 has a personal caregiver Monday through Friday. Interviews with the caregiver indicate that R1 does not fall under their supervision. The personal caregiver has offered weekend services to R1, but R1 has declined the additional support.

LPA conducted interviews with eight (8) residents. R1 informed LPA that staff do take steps to prevent falls. R1 acknowledged experiencing recent falls and stated they become frustrated wanting to stand up on their own. Five (5) of the eight (8) residents reported that staff prevent falls, while three (3) residents stated they either did not know or could not answer whether staff prevent residents from falling.

Regarding Allegation #2, it was alleged that staff did not report an incident to the resident’s responsible party. LPA conducted interviews with eight (8) staff members. Based on the interviews, medication technicians are responsible for notifying responsible parties when residents experience falls. LPA reviewed documentation completed by the medication technician, which indicates that R1’s fall was reported to the responsible party as well as all other required parties.

Seven (7) of the eight (8) staff reported that responsible parties are notified, with one (1) of those seven stating they have never heard of a situation where a responsible party was not informed. One (1) of the eight (8) staff stated they were unsure whether responsible parties are consistently notified; they indicated they are told that families are notified but do not know if the notification actually occurs.

LPA conducted interviews with eight (8) residents. R1 reported that their responsible party is notified when they experience falls, noting that their family typically calls to follow up and verify the incident. However, R1 stated they are unsure whether their family is notified after every fall, as the family does not always initiate a follow-up call.

Among the remaining residents, four (4) of the eight (8) stated either that their responsible parties are notified, that they have been informed responsible parties are notified, or that they assume notification occurs. The other four (4) residents reported they did not know or could not answer whether their responsible parties are notified.

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated; meaning that although the allegations 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 where this report was discussed and a copy was provided to Executive Director Cristina Ceballos at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/10/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026

LIC9099 (FAS) - (06/04)

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