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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 02/06/2025
Date Signed: 02/06/2025 03:15:08 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
12/06/2024 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20241206134558
FACILITY NAME:LAKES, THEFACILITY NUMBER:
336409176
ADMINISTRATOR:LORI MATSUSHITAFACILITY TYPE:
740
ADDRESS:5801 SUN LAKES BLVDTELEPHONE:
(951) 845-2220
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:237CENSUS: 105DATE:
02/06/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Executive Director Cristina CeballosTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly taking care of residents.
Staff are not providing nutritious meals to residents.
INVESTIGATION FINDINGS:
1
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 deliver findings on a complaint investigation on the above allegations. LPA met with Executive Director Cristina Ceballos, and discussed the purpose of the visit.

Regarding allegation #1, LPA Ramirez conducted 11 resident interviews. 6 out of 11 residents informed LPA staff are providing proper care. 2 out of 11 residents explained to LPA they are independent, but staff are providing residents with proper care. 3 out 11 residents informed LPA staff can provide better care to residents.

LPA conducted 5 staff interviews. 5 out of 5 staff indicated proper care is being provided to the residents. Executive Director informed LPA they are currently short staffed, however they hired new staff since LPA’s last visit and are currently in the process of hiring more caregivers.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
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-20241206134558
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: 336409176
VISIT DATE: 02/06/2025
NARRATIVE
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Regarding allegation #2, LPA conducted 11 resident interviews. 4 out of 11 residents informed LPA staff provide nutritious meals. 7 out of 11 residents informed LPA the nutritious meals being provided could be better.

LPA conducted 4 staff interviews. 2 out of 4 staff informed LPA the meals being provided to residents are nutritious. 2 out of 4 staff stated the nutritious meals could be better, especially for the residents who are diabetic. Executive Director informed LPA the meals being provided to residents have been approved by a dietitian and meal options have been changing upon resident requests.

Based on LPAs observations, record review, and interviews, the above allegations are Unsubstantiated. A finding that 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.

An exit interview was conducted, and this report was discussed and provided to Executive Director Cristina Ceballos.


SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2