336409176-6-21-2023-56-AS-KCLS-CUAKYW-20230801081945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 06/21/2023
Date Signed: 06/21/2023 10:09:34 AM

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
05/23/2023 and conducted by Evaluator Magda Malcore

COMPLAINT CONTROL NUMBER: 56-AS-20230523134613

FACILITY NAME:	LAKES, THE		FACILITY NUMBER:	336409176
ADMINISTRATOR:	LORI MATSUSHITA		FACILITY TYPE:	740
ADDRESS:	5801 SUN LAKES BLVD		TELEPHONE:	(951) 845-2220
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	237	CENSUS: 99	DATE:	06/21/2023
		UNANNOUNCED	TIME BEGAN:	09:02 AM
MET WITH:	Administrator, Lori Matsushita		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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The facility is in disrepair
The facility has a bug infestation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced visit to deliver the findings on the above complaint allegations. LPA met with Administrator, Lori Matsushita and discussed the purpose of the visit.

Regarding the allegation that the facility has a bug infestation, LPA toured the facility and found no evidence of a bug infestation. Review of invoices from facility’s pest management company reveal that the facility was treated for pest in March, April, and May. The interior and exterior of the facility was treated for various pest control including roaches, earwigs, and silverfish. Residents interviewed deny facility has a bug infestation and deny finding bugs in their beds.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

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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Control Number 56-AS-20230523134613

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: LAKES, THE	FACILITY NUMBER: 336409176
	VISIT DATE: 06/21/2023

NARRATIVE

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Regarding the allegation the facility is in disrepair, it is alleged that a roof leak in Memory Care had not been repaired for months. LPA toured Memory Care and observed dried water stains on a ceiling panel located in west hallway. The carpet did not appear soiled and the area was odor free. The Administrator stated that there was a roof leak in Memory Care. A maintenance request was initiated on 5/23/23 and the leak was repaired the same day. Staff and resident interviews deny that the facility is in disrepair and there is not enough evidence to corroborate that the roof leak had not been repaired for months.
Based on LPA observations, record review, and interviews conducted, the above allegations are Unsubstantiated; although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed, and a copy of this report was provided to at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023

LIC9099 (FAS) - (06/04)

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