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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 365530102
Report Date: 10/27/2025
Date Signed: 10/27/2025 11:45:46 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
10/20/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251020101251
FACILITY NAME:LOTUS VILLA AND MEMORY CAREFACILITY NUMBER:
365530102
ADMINISTRATOR:HEATHER O'NEELFACILITY TYPE:
740
ADDRESS:9448 CITRUS AVENUETELEPHONE:
(909) 355-6887
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:99CENSUS: 94DATE:
10/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Melisa Sevilla- AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff are not properly addressing bed bugs in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Melisa Sevilla and explained the purpose of the visit. The investigation consisted of interviews, review of records, and observations.

First allegation: Facility staff are not properly addressing bed bugs in the facility. Regarding the allegation, LPA conducted interviews with Staff #1, Staff #2, and Staff #3, who informed LPA that the facility received a report from a resident on 10/7/2025 regarding bedbugs. Based on treatment contract LPA observed that a two-day treatment was completed on 10/13 and on 10/24/2025, staff informed LPA that treatment has been completed, and the indication of bedbugs was no longer present. In addition, Staff informed LPA that a total of four (4) residents will be moving back into their rooms in the next couple of days. LPA conducted interviews with R#2, R#3, and R#4, who informed LPA that they have no bedbug bites, and that they are aware of the treatment that is being done in their rooms.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
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-20251020101251
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: LOTUS VILLA AND MEMORY CARE
FACILITY NUMBER: 365530102
VISIT DATE: 10/27/2025
NARRATIVE
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R#2, R#3, and R#4, informed LPA that they have no concerns and that they are waiting to receive the clearance to return back to their rooms. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated: meaning that 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 (LIC 9099) was discussed, and a copy was provided to Facility Administrator Melisa Sevilla at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2