336407734-7-23-2025-18-AS-JDHS-DJWSNT-20250725140201

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 07/23/2025
Date Signed: 07/23/2025 02:53:41 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
03/28/2024 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240328100409

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:	45	CENSUS: 38	DATE:	07/23/2025
		UNANNOUNCED	TIME BEGAN:	02:15 PM
MET WITH:	ADMINISTRATOR, GENESSIS GARCIA		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not prevent resident from getting injured while in care

INVESTIGATION FINDINGS:

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On July 23, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced and met with Administrator, Genessis Garcia. LPA explained the reason for the visit was to provide findings for the allegation listed above.

On March 28. 2024, Community Care Licensing received a complaint alleging staff did not prevent resident from getting injured while in care. During the investigation, LPA conducted interviews, record reviews, and made observations. It was reported Resident #1 (R1) had a bruise on their eye and bruising on their hand. Additionally, it was reported the facility staff did not know how it occurred but advised R1’s roommate can be aggressive and may have hit R1. Information obtained from interview with Administrator stated R1 had bruises on their hand, but did not have a bruised eye. Administrator also denied that the bruises did not come from being hit by R2 because R2 is on hospice and require full assistance to transfer from bed to chair. Information obtained from interviews with staff confirmed R1 had bruises on their hand. Additional staff further advised there were no observed or documented incidents of R2 being aggressive towards R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025

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 18-AS-20240328100409

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PICO DE LORO	FACILITY NUMBER: 336407734
	VISIT DATE: 07/23/2025

NARRATIVE

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Information obtained from interview with R1 did not indicate they had any bruises, due to R1 not able to coherently answer questions pertaining to the allegation. Information obtained from interview with R2 indicated there was no hitting and/or fighting, between them. Additionally, there were no interactions between R1 and R2. Information obtained from interviews with additional residents stated they were not aware of any of the residents being involved in any kind of altercation. Residents were unable to advise if they observed R1 to have a bruised eye or hand. LPA’s review of the records confirmed R1 and R2 had been receiving services through hospice care since being admitted to the facility. LPA made several attempts to obtain hospice notes regarding whether R1 was observed to have a bruised eye or hand. LPA was unable to obtain any additional documents. On 03/28/2024, LPA made observations of R1 and observed skin discoloration on R1’s hands, however, LPA did not observe any bruising to the eyes.

Based on information obtained from interviews, record reviews, and observations, the information obtained regarding the allegation staff did not prevent residents from getting injured while in care was not sufficient. Due to the inability to obtain pertinent documentation, and additional hospice records, the allegation has been deemed unsubstantiated. An allegation deemed
unsubstantiated means although the allegation may have happened, but there is not a preponderance of the evidence to demonstrate if the alleged violation did nor did not occur.

An exit interview was conducted, and a copy of this report was discussed and provided to Administrator, Genessis Garcia.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2025

LIC9099 (FAS) - (06/04)

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