336407346-1-9-2024-56-AS-EMAN-CZYP67-20240130100152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407346
Report Date: 01/09/2024
Date Signed: 01/09/2024 02:20:35 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/02/2024 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240102155224

FACILITY NAME:	WILDOMAR SENIOR ASSISTED LIVING		FACILITY NUMBER:	336407346
ADMINISTRATOR:	CRISTINA MILLER		FACILITY TYPE:	740
ADDRESS:	32365 SOUTH PASADENA ST.		TELEPHONE:	(951) 678-1555
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	152	CENSUS: 90	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Cristina Miller- Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not provide resident with a 60day notice of fee increase.
Staff are not providing adequate linen for residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegations listed above. LPA stated the purpose of the visit, was granted entry, and met with Administrator Cristina Miller. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Staff did not provide resident with a 60day notice of fee increase:

It was alleged that the facility increased Resident R1’s rent in January of 2024 without proper notice. Interviews with Resident R1 and interviews with the staff revealed that the facility did not increase R1’s rent. It was revealed that R1 is on a program that assists the resident with a lower rate of rent. The program sent out a notice on November 28th, 2023, that stated starting January 1st, 2024, there is an increase in rent for the residents on the program. This program is not run by the facility and fees are dictated by the program, not the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/02/2024 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240102155224

FACILITY NAME:	WILDOMAR SENIOR ASSISTED LIVING		FACILITY NUMBER:	336407346
ADMINISTRATOR:	CRISTINA MILLER		FACILITY TYPE:	740
ADDRESS:	32365 SOUTH PASADENA ST.		TELEPHONE:	(951) 678-1555
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	152	CENSUS: 90	DATE:	01/09/2024
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Cristina Miller- Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not allowing residents to use the pool.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegation listed above. LPA stated the purpose of the visit, was granted entry, and met with Administrator Cristina Miller. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Staff are not allowing residents to use the pool:

Interview with the Administrator revealed that the facility has a pending application for a change of ownership. During this process, the pool, the senior center/clubhouse, and an adjacent building where independent adults reside is no longer is owned by the facility. This independent building is not licensed by the State of California through the Community Care Licensing Division. Prior to the application of change of ownership, the facility owned these three (3) areas on the property.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 56-AS-20240102155224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING	FACILITY NUMBER: 336407346
	VISIT DATE: 01/09/2024

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

On 1/8/2024, the Administrator inquired with the independent building staff to verify if the assisting living residents could use the pool and was informed by their staff that they were not allowed to give access to the assisted living residents.

During document review of the facilities map, LPA found that the pool is included on the facilities map and is currently included in the facilities active license. LPA also found that the facility has a brochure posted on their website, Wildomarsenior.com, that is promoting the use of the pool and the spa. The pool and the spa on the property are listed on the website as one of the amenities available to the assisted living residents.

Based on evidence obtained during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D form were discussed and provided to Administrator Cristina Miller, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 56-AS-20240102155224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING	FACILITY NUMBER: 336407346
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/09/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/01/2024 Section Cited CCR 87208(a)(7)(B)	1 2 3 4 5 6 7	87208 Plan of Operation (a) Each facility shall have and maintain a current, written definitive plan of operation. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following: (7) Sketches, showing dimensions, of the following: (B) The grounds showing buildings, driveways, fences, storage areas, pools, gardens, recreation area and other space used by the residents.	1 2 3 4 5 6 7	The licensee has agreed to read regulation 87208 entirely and send LPA a statement of understanding that the regulation was read and understood. The licensee has agreed send an updated plan of operation by the POC date. POC is due by 2/1/2024.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by interview, document review, and observation, the licensee did not comply with the section cited above evidenced by not allowing residents touse the poolw which poses a potential health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 56-AS-20240102155224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING	FACILITY NUMBER: 336407346
	VISIT DATE: 01/09/2024

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

Document review of R1’s rent statement for January 2024 and the notice sent out by the program indicates the same amount due.

For allegation, Staff are not providing adequate linen for residents:

It was alleged that the quality of the towels is not adequate. During interviews with the staff and the residents it was revealed that the facility has adequate towels for residents. Interviews revealed that the towels are clean, do not have holes, and or rips in the towels. LPA was shown a stock of towels in a storage room, as well as towels in the resident’s rooms. LPA did not observe dirty towels, towels with rips, and or towels with holes. During document review of linen statements, LPA was shown five (5) statements for the month of December 2023 and two (2) statements for the month of November 2023. In these statements, the facility is charged and provided with a replenishment towels every week.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC811 were discussed and provided to Administrator Cristina Miller, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5