<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604135
Report Date: 12/02/2025
Date Signed: 12/02/2025 03:29:45 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
05/16/2023 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20230516083948
FACILITY NAME:SHADOWRIDGEFACILITY NUMBER:
374604135
ADMINISTRATOR:BEATRICE BRACAMONTEFACILITY TYPE:
740
ADDRESS:2354 WATSON WAYTELEPHONE:
(760) 295-3888
CITY:VISTASTATE: CAZIP CODE:
92081
CAPACITY:0CENSUS: 0DATE:
12/02/2025
UNANNOUNCEDTIME BEGAN:
02:54 PM
MET WITH:TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff refused to accept resident back after hospital stay.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/2/25 Licensing Program Analyst (LPA) Deborah Lee conducted a follow-up investigation to determine findings of the above-mentioned allegation.

The investigation consisted of the following:
On 5/19/23 Licensing Program Analyst (LPA) Janira Arreola conducted an initial visit to facility to investigate allegations listed above. During the visit, the LPA conducted interviews, documented observations, and conducted records reviews. At time of visit, it was determined that further investigation is needed before determining the findings.

On 12/02/25, Licensing Program Analyst (LPA) Deborah Lee conducted a follow-up investigation. LPA was able to speak with the Reporting Party who confirmed allegations and added a few more statements regarding the facility.

Page 1 of 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
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 18-AS-20230516083948
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
FACILITY NUMBER: 374604135
VISIT DATE: 12/02/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff refused to accept resident back after hospital stay

The detail of the complaint alleges that R1 was admitted to the hospital for an evaluation and was discharged the same day. The facility refused to allow R1 to return and did not provide an eviction notice.

On 12/02/25, LPA Lee reviewed, and evaluated the following documents: R1 Physician's report (dated 3/3/23), House rules for conduct (dated 3/21/23), Physician's orders (dated 4/1/23) R1’s Discharge document (dated 3/16/23), Outside agency notes (dated: 5/2/23, 4/26/23), Physician's communication (dated: 4/10/23), and R1's Individual Service Plan (ISP) for ALW program (dated: 5/26/22).

At the time of the investigation follow-up, no staff or resident interviews were available regarding this complaint. As a result, there is insufficient evidence to support the allegation. While the allegation may have occurred or may be valid, the evidence does not meet the standard of a preponderance to confirm whether the violation did or did not take place. Therefore, the allegation is classified as UNSUBSTANTIATED.

This facility closed on 4/7/2023

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

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

DATE: 12/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2