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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 03/21/2024
Date Signed: 05/15/2024 09:22:47 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
03/05/2024 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240305095021
FACILITY NAME:PICO DE LOROFACILITY NUMBER:
336407734
ADMINISTRATOR:VIVIEN RILLO/EFREN RILLOFACILITY TYPE:
740
ADDRESS:620 NORTH PERRIS BLVDTELEPHONE:
(951) 943-8081
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:43CENSUS: DATE:
03/21/2024
UNANNOUNCEDTIME BEGAN:
03:36 PM
MET WITH:Administrative Assistant Yamberly Genesis Garcia TIME COMPLETED:
04:36 PM
ALLEGATION(S):
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Staff did not provide responsible party 60 day notice of fee increases
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to deliver findings regarding the allegation listed above. LPA was granted entry and met with Administrative Assistant Yamberly Genesis Garcia, who was Informed of the purpose of the visit.

Regarding the allegation “Staff did not provide responsible party 60-day notice of fee increases”, it was alleged a verbal, not written, notice was given to Resident 1 (R1) and/or their Power of Attorney (POA) regarding an increase in the monthly rate for R1. Interview with Administrator (AD) Efren Rillo revealed an increase in the level of care was needed for R1, and their monthly rate was adjusted to reflect the increase. AD Rillo also revealed he only provided a verbal notice concerning the increased rate. Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6), are being cited on the attached LIC 9099 D.
An exit interview was conducted, and a copy of this report was provided to Rillo along with LIC811- Confidential Names list and Appeal Rights.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
03/05/2024 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240305095021

FACILITY NAME:PICO DE LOROFACILITY NUMBER:
336407734
ADMINISTRATOR:VIVIEN RILLO/EFREN RILLOFACILITY TYPE:
740
ADDRESS:620 NORTH PERRIS BLVDTELEPHONE:
(951) 943-8081
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:43CENSUS: DATE:
03/21/2024
UNANNOUNCEDTIME BEGAN:
03:36 PM
MET WITH:Administrative Assistant Yamberly Genesis GarciaTIME COMPLETED:
04:36 PM
ALLEGATION(S):
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Staff did not provide responsible party with an itemized list
Illegal eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to deliver findings regarding the allegation listed above. LPA was granted entry and met with Administrative Assistant Yamberly Genesis Garcia who was Informed of the purpose of the visit.

Regarding the allegation “Staff did not provide responsible party with an itemized list”, it was alleged Administrator Rillo did not have a comprehensive list for evaluating R1’s service needs and the fee schedule for items and services provided with the 60-day rate increase written notice. On 11/02/2023, R1’s POA received a written notice indicating due to the change in the level of care for R1, a change of rate will be adjusted with an effective date of 01/01/2024 with a first due date of 01/26/2024. The written notice has an “Admission Financial Agreement” attached with an itemized list breakdown of the adjusted rate of $6,596.05. The itemized list had “Room and Board” with a price of $1,324.82, “Level of Care” with a price of $5,071.23, “Incontinent Care Fee/Supplies” with a price of $200.00.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
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 4
Control Number 18-AS-20240305095021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PICO DE LORO
FACILITY NUMBER: 336407734
VISIT DATE: 03/21/2024
NARRATIVE
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Level of care Assessment is modeled off the Assisted Living Waiver Program Assessment Tool. Scores are categorized as Tier 1: Independent, Tier 2: Supervision, Tier 3: Limited Assistance, Tier 4: Extensive Assistance, and Tier 5: Total Dependence. The written notice sent to R1’s POA had a “ADL Self Performance Assessment” attached scoring R1’s “Level of Care” as “Tier 5: Total Dependence” for categories “Bed Mobility”, “Transfer”, “Dressing”, “Eating”, “Toilet Use”, “Personal Hygiene”, and “Bathing” . Pricing for Level of Care is modeled off the Assisted Living Waiver Program 2023 rates for Level of Care with Tier 1: $88.60 per participant per day, Tier 2: $105.86 per participant per day, Tier 3: $123.12 per participant per day, Tier 4: $166.27 per participant per day, and Tier 5: $250.00 per participant per day. The last page of the ADL Self Performance Assessment has a note signed by Administrator Efren Rillo stating R1 was assessed at Tier 5 level of care but will be charged at Tier 4 rates of $166.27 per day. Interview with Administrator Rillo revealed they lowered the level of care Tier rate for R1 due to R1 living at this facility for 10 years. Therefore based on interviews and records review, the allegation "Staff did not provide responsible party with an itemized list" has been deemed UNFOUNDED at this time.

Regarding the allegation “illegal eviction”, it was alleged Pico De Loro is now in the process of evicting R1 due to not being able to afford the adjusted rate of care. Interview with Administrator Rillo stated they have not started the process of evicting R1 and they had no intention of evicting R1. Administrator stated R1’s Power of Attorney (POA) is delinquent in payment and has not paid for the months of January 2024 and February 2024. Interview with R1’s POA revealed that R1 was currently at the facility, R1 had not been evicted, and POA did not receive an eviction notice. Record review of text messages revealed POA was aware of the delinquent of payments for two months and informed Administrator Rillo they understood due to their delinquency in payment R1 may be evicted. This agency has investigated the complaint alleging “illegal eviction. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to Garcia.
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240305095021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PICO DE LORO
FACILITY NUMBER: 336407734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2024
Section Cited
HSC
1569.655(a)
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Increase in fee rates for elderly residents...: (a)If a licensee of a residential care facility for the elderly increases the rates... the licensee shall provide no less than 60 days' prior written notice to the residents...
This requirement was not bet as evidenced by:
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Licensee will review Health and Safety Code 1569.655 and send a statement of understanding to CCL by POC date.
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Based on interviews, Licensee failed to give R1's Power of Attorny a 60-day written notice regarding the fee increase and only gave the POA a verbal notice. This poses a potential risk to residents in care.
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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: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:

DATE: 03/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4