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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604135
Report Date: 12/22/2025
Date Signed: 12/22/2025 02:59:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
06/10/2024 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20240610094045
FACILITY NAME:SHADOWRIDGE SENIOR LIVINGFACILITY NUMBER:
374604135
ADMINISTRATOR:DUBOSE, LEVINAFACILITY TYPE:
740
ADDRESS:2354 WATSON WAYTELEPHONE:
(760) 295-3888
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:0CENSUS: 0DATE:
12/22/2025
UNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:TIME COMPLETED:
02:32 PM
ALLEGATION(S):
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Staff does not ensure residents are spoken to in an appropriate manner
Staff does not ensure personal privacy is accorded to residents in care
Staff not allowing the residents to choose their meals
INVESTIGATION FINDINGS:
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On 12/22/25, Licensing Program Analyst (LPA) Deborah Lee conducted a follow-up investigation to determine findings of the above-mentioned allegations.

The investigation consisted of the following:
On 6/12/23 Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an initial visit to facility to investigate allegations listed above. During the visit, the LPA conducted review of records, obtained and requested copies of pertinent documents. At time of visit, it was determined that further investigation is needed before determining the findings.

On 12/22/25, Licensing Program Analyst (LPA) Deborah Lee conducted a follow-up investigation and attempted to contact the reporting party for an interview. However, the LPA was unable to interview the reporting party.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025
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 3
Control Number 18-AS-20240610094045
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SHADOWRIDGE SENIOR LIVING
FACILITY NUMBER: 374604135
VISIT DATE: 12/22/2025
NARRATIVE
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Allegation: Staff does not ensure residents are spoken to in an appropriate manner

The detail of complaint alleges, “the staff will yell at them and say things like "mind your own business…and shut up"

At the time of investigation follow-up, there were no available records to review or interviews of staff and residents for this complaint. There is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

Allegation: Staff does not ensure personal privacy is accorded to residents in care

The detail of complaint alleges that staff do not allow residents to have private conversations while in the dining hall.”

At the time of investigation follow-up, there are no available records to review or interviews for this complaint. There is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20240610094045
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SHADOWRIDGE SENIOR LIVING
FACILITY NUMBER: 374604135
VISIT DATE: 12/22/2025
NARRATIVE
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Allegation: Staff does not allow residents to choose their meals.

“The detail of complaint alleges that staff tells the residents what to eat.”

At the time of investigation follow-up, there are no available records to review or interviews for this complaint. There is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

This facility closed 4/7/2025

A copy of this report will be mailed to last known address: 2354 Watson Way Vista CA 92081

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025
LIC9099 (FAS) - (06/04)
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