336407734-3-29-2023-18-AS-JDHS-CR3PG2-20230420111734

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 03/29/2023
Date Signed: 03/29/2023 04:20:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/28/2023 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230328122459

FACILITY NAME:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	39	CENSUS: 32	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	ADMINISTRATOR, EFREN RILLO.		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility force feeds residents.
Facility not ensuring that resident is adequately hydrated.

INVESTIGATION FINDINGS:

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On March 29, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to investigate a complaint regarding the listed allegations. LPA Mixson met with Administrator introduced self and stated the purpose of the visit.

Present in the facility are 32 residents and 10 staff including caregivers. LPA Mixson toured the facility, along with the Administrator, and there were no health and safety concerns observed. During this visit LPA Mixson conducted staff and resident interviews, requested and received pertinent documentation, and made observations pertaining to the listed allegations.
After assessment of evidence received, the outcome of the allegation findings was deemed UNSUBSTANTIATED. A finding of unsubstantiated means that, "Although the allegation may have happened or is valid, there is not a preponderance of evidence strand to prove the alleged violations did or did not occur." Therefore, the allegation is found unsubstantiated at this time. LPA Mixson conducted staff and resident interviews, toured the facility, made observation, and reviewed pertinent documentation. Information obtained through interviews and records review was not enough to demonstrate that the listed allegations did or did not occur.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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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