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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 10/20/2025
Date Signed: 10/20/2025 02:18:06 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
08/17/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20250817234904
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: 139DATE:
10/20/2025
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Executive Director Cristina CebellosTIME COMPLETED:
02:35 PM
ALLEGATION(S):
1
2
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8
9
Staff do not timely respond to the residents alerts
Staff do not provide adequate food service
INVESTIGATION FINDINGS:
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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 and deliver findings on the above allegations. LPA met with Executive Director Cristina Ceballos, and discussed the purpose of the visit.

Regarding allegation #1, LPA conducted interviews with four (4) staff, 3 out of 4 staff informed LPA they respond to call pendants within 3-10 minutes minimum, however if they are assisting other residents their response time can vary between 10-20 minutes max.

LPA conducted interviews with six (6) residents, all 6 residents informed LPA they hardly use their call pendants; but the times they have staff attend in a timely manner. 4 out of 6 residents stated they have waited 5-20 minutes for staff to respond.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
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-20250817234904
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: 10/20/2025
NARRATIVE
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While interviewing a resident, LPA had the resident test their call pendant. LPA observed two (2) staff respond to the call in 6 minutes and 36 seconds.

Regarding allegation #2, LPA conducted interviews with four (4) staff, all four have informed LPA the residents have not complained about the food however, it’s got better.

LPA conducted interviews with six (6) residents, 4 out of 6 residents informed LPA the food is good and they do not have complaints, 1 of the 6 residents stated the food is so-so, 1 of the 6 residents informed LPA they are a picky eater; however with the alternatives the food is good.

Based on observation, interviews, and pertinent documents the allegations are unsubstantiated. An Unsubstantiated complaint means, that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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: 10/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2