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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 07/08/2022
Date Signed: 07/08/2022 10:46:46 AM

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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2022 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20220630114211
FACILITY NAME:LAKES, THEFACILITY NUMBER:
336409176
ADMINISTRATOR:TERRY RECORDSFACILITY TYPE:
740
ADDRESS:5801 SUN LAKES BLVDTELEPHONE:
(951) 845-2220
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:237CENSUS: 91DATE:
07/08/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Amanda McElwain, Memory Care DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Illegal eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation of an illegal eviction. LPA Prieto met with Memory Care Director Amanda McElwain to discuss the elements of the complaint. McElwain states that resident #1 (R1), in question, was not evicted and continues to be resident of the facility. R1 was transferred to a skilled nursing facility (SNF) for a specific medical condition and McElwain in contact with the SNF pending R1's return to the facility. McElwain, provided LPA Prieto with documentation pertaining to R1's medical diagnosis and incident relating to R1's transfer to a medical facility and subsequent transfer to the SNF.

Based on the information obtained there is not enough evidence that the facility Illegal evicted resident #1. Therefore, the allegations is deemed UNSUBSTANTIATED at this time. The report was signed by LPA Prieto and Executive Director Amanda McElwain and a copy was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2022
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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