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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850365
Report Date: 06/15/2026
Date Signed: 06/15/2026 01:17:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2026 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20260316082212
FACILITY NAME:FOUNTAIN SQUARE OF LOMPOCFACILITY NUMBER:
425850365
ADMINISTRATOR:MESHELL RAMOSFACILITY TYPE:
740
ADDRESS:1420 W NORTH AVENUETELEPHONE:
(805) 736-1234
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:130CENSUS: 53DATE:
06/15/2026
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Administrator, Meshell RamosTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff do not answer call buttons in a timely manner.

Staff do not ensure the resident's medication is provided as needed.
INVESTIGATION FINDINGS:
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 At 8:15am on 06/15/2026, Licensing Program Analyst (LPA) Jeffries arrived at the facility unannounced to conduct a continuing complaint investigation visit to the allegations to this complaint. LPA was also at the facility to conduct a second initial investigation visit to the allegations on a separate complaint (29-AS-20260609083723 and 29-AS-20260605145935), LAP was able to issue final findings to that second initial complaint on this visit. Additionally, LPA continued investigations on two additional and separate complaints (29-AS-20260501133657, and 29-AS-20260422105446), LPA also issued final findings on complaint 29-AS-20260316082212 and continued investigation to address the allegations to an additional two separate complaints (29-AS-20260422105446, and 29-AS-20260501133657). Today’s visit LPA was addressing two new complaints and three prior complaints, closing one older complaint and closing one new complaint on this visit for a total of five separate complaints addressed on this investigation visit.Final findings to the allegations to this complaint are as follows:
As to the allegation of, “Staff do not answer call buttons in a timely manner.” It was alleged that on 03/14/2026,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
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 5
Control Number 29-AS-20260316082212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 06/15/2026
NARRATIVE
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Resident 1 (R1) had called for assistance with medication at 6:30am, and as of 8:30am the request for medication had not been satisfied. On 03/18/2026 Licensing Program Analyst (LPA) Jeffries conducted an in-person interview with R1. R1 stated that staff do not respond to the call button when pressed, and R1 has to wait up to 2 hours for staff to respond. On 03/18/2026 LPA conducted in-person interviews with Staff, S1, S2, and S3, all who stated that R1 would refuse to let staff clear call button, refuse showers, refuse incontinent assistance, and refuse medication often. On 04/15/2026 LPA conducted documentation audit of call button times for 6 rooms all in same hallway of R1’s room for the time period between 03/09/2026 and 03/17/2026.. Facility call button log for those 6 rooms during that time frame shows 16 calls for service took more than 1 hour to clear, 38 calls for service took more than 30 minutes to clear and 79 calls for service took more than 10 minutes to be cleared. Call button logs for R1’s room on 03/14/2026 show 36 calls for services, and 5 of 36 calls show longer than 20 minutes to respond. On 03/14/2026 R1 had pressed the call button at 5:17am and the call button log shows that that call was cleared 1 hour and 51 minutes (1:51) later, additionally R1 press button for call of service at 7:30am, the call button log shows that that call was cleared 1 hour and 45 minutes (1:45) later. There were no Facility Narrative Charting notes for the date of 03/14/2026, as not being able to clear call button logs. Based on interviews, observation and documentation, at this time there is enough evidence to support the allegation of, “Staff do not answer call buttons in a timely manner.” and is substantiated at this time.
As to the allegation of, “Staff do not ensure the resident's medication is provided as needed.” It was alleged that, on 03/16/2026, Resident 1 (R1) had requested a PRN medication at 6:30am via the call button, R1 spoke with Staff (S2) and as of 8:30am on 03/16/2026 R1 still had not received their requested PRN medication. On 03/18/2026, Licensing Program Analyst (LPA) Jeffries conducted an in-person interview with R1 who stated that the facility is constantly late with all medication passes and take their time when a PRN is requested, R1 stated, the facility finally did provide the PRN on 03/16/2026, but was not sure of what time it eventually was provided that morning after 8:30am. On 04/15/2026, LPA reviewed R1’s Centrally Stored Medication Records (CSMR) and Medication Administration Records (MAR) for the month of March 2026. LPA noted that there were no PRN medications provide to R1 according to the MAR on March 15th or 16th of 2026. On 03/18/2026 LPA conducted interviews of Staff 1, S2 and S3, who stated they did not recall what time R1’s PRN was provided on 03/16/2026. Based on interviews, and facility records this is sufficient evidence at this time to support the allegation of, “Staff do not ensure resident’s medication is provide as needed.” and is substantiated at this time.

Exit interview, report read, appeal rights and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2026 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20260316082212

FACILITY NAME:FOUNTAIN SQUARE OF LOMPOCFACILITY NUMBER:
425850365
ADMINISTRATOR:MESHELL RAMOSFACILITY TYPE:
740
ADDRESS:1420 W NORTH AVENUETELEPHONE:
(805) 736-1234
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:130CENSUS: 53DATE:
06/15/2026
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Administrator, Meshell RamosTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff left residents in soiled bedding for an extended period of time.
Staff handle residents in a rough manner.
Staff do not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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 As to the allegation of, “Staff left resident in soiled bedding for an extended period of time.” It was alleged that, on 03/16/2026, R1 reported that they spoke with the S2 through the call button at 7:30 AM, requesting medication and informing that they were sitting in urine. On 03/18/2026 LPA conducted an in-person interview with R1 who stated that they would refuse incomitance help when S4 and other male staff were on duty. R1 stated that on 03/16/2026 they don’t remember how long they waited, to be changed, and then stated that S4 was not allowed to provide any care to R1 as agreed to by Administrator. During that interview, LPA noted that R1 had 4 different staff enter R1’s room 6 distinct and different times in a 30-minute period, including medication, shower, incontinence change, and food service. LPA observed R1 holding on to their call button with staff not attempting to clear. On 03/18/2026, LPA conducted in-person interviews with S1, S2, and S3 who all stated, R1 refused to be changed on the morning of 03/16/2026 and refused to let staff clear call button.
CONTINUED on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20260316082212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
VISIT DATE: 06/15/2026
NARRATIVE
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 On 04/15/2026, LPA reviewed call button log for the morning of 03/14/2026 and noted that there were 4 call button logs starting at 6:39am, 7:37am, 8:21am and 8:24am. LPA noted that all calls exceeded 23 minutes due to R1’s refusal to allow staff to clear call button log. LPA also noted that the call button at 8:21am was cleared by staff in less than 1 minute. Based on interviews, documentation, and observation there is not enough evidence to support the allegation of, “Staff left resident in soiled bedding for an extended period of time.” and is unsubstantiated at this time.

As to the allegations of, “Staff handle resident in a rough manner.” and “Staff do not treat resident with dignity and respect.” It was alleged that R1 had reported that when staff provide bed baths, they are rough, causing pain in privet areas. R1 also stated that staff speak in their own language (Spanish) around R1 and that they make fun of R1, laughing as they bathe or assist R1. On 03/18/2026 LPA conducted an in-person interview with R1 who stated that the staff intentionally speak Spanish and laugh when assisting R1 with bathing and transfers. R1 stated that they did not know what the staff were saying but would also laugh when speaking Spanish around R1. R1 denied understanding Spanish language. On 03/18/2026, LPA conducted interviews with S1, S2, and S3 who stated that their primary language is Spanish and it is only spoken to help them better assist R1 when providing care that require more than one staff. S1, S2, and S3 all deny laughing while providing care for R1. All deny making fun of R1 while providing care. On 04/15/2026 LPA conducted a documentation review of S1, S2, S3, S4, S5 and S6 who all have current regulation required training that includes but not limited to, Assisting with Proper Positioning, Residents Rights in Assisted Living, Cultural Awareness and Humanities, Transferring Safely, Urinary Incontinence, Residents Rights in Assisted Living, and Reporting Abuse. Based on interviews, and documentation, at this time there is not enough evidence to support the allegations of, “Staff handle resident in a rough manner.” and “Staff do not treat resident with dignity and respect.”

Exit interview, report read, and report provided.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20260316082212
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: FOUNTAIN SQUARE OF LOMPOC
FACILITY NUMBER: 425850365
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/15/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/29/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents’ needs. … This requirement was not met by the number of call response that resulting in call button times exceeding
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Administrator agrees to conduct a training will all staff on address call button calls, how recongnuze and write a procedue for staff to recognize, address, and clear call button calls in the facility. To be completed by 06/29/2025 and email LPA documentation.
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more than 10 minute response times as indicated in the complaint, which poses a potential danger to residents in care.
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Type B
06/29/2026
Section Cited
CCR
87465((a)(6)
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(a) A plan for incidental medical .. each facility. The plan shall encourage routine medical …such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by
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Administrator agrees to have all medication technitions to complete a 1 hour additional training on documentation of medication. To be completed by 06/29/2025 and email LPA documentation.
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 the facility. This requirement was not met by evidence of facility documentation failing to record dosage of medication provided on 03/16/2026 which poses a potential danger to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5