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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800055
Report Date: 03/05/2026
Date Signed: 03/05/2026 01:39:07 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
04/28/2025 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20250428151030
FACILITY NAME:COTTAGES AT HEMETFACILITY NUMBER:
331800055
ADMINISTRATOR:BOTTINELLI,SHEILAFACILITY TYPE:
740
ADDRESS:1177 S PALM AVETELEPHONE:
(951) 923-2844
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:110CENSUS: 69DATE:
03/05/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Barbara Bogoje, Executive DirectorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Resident sustained a fracture and bruising due to neglect/lack of care supervision.
INVESTIGATION FINDINGS:
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On 03/05/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross made an unannounced visit to the facility to deliver the finding for the allegation noted above. LPA met with Barbara Bogoje, Executive Director and explained the purpose of the visit. The investigation consisted of interviews and records review.

On 04/28/2025, Community Care Licensing received a complaint alleging resident (R1) sustained a fracture and bruising due to neglect and/or lack of care and supervision. It was reported R1 had an unwitnessed fall.

Interviews were conducted with staff which revealed that on 04/21/2025, two caregivers on duty were assisting residents when they heard a loud noise and when the caregivers responded to the noise, they found R1 on the floor beside their walker.

Continue on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2026
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
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
04/28/2025 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20250428151030

FACILITY NAME:COTTAGES AT HEMETFACILITY NUMBER:
331800055
ADMINISTRATOR:BOTTINELLI,SHEILAFACILITY TYPE:
740
ADDRESS:1177 S PALM AVETELEPHONE:
(951) 923-2844
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:110CENSUS: 69DATE:
03/05/2026
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Barbara Bogoje, Executive DirectorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for resident.
INVESTIGATION FINDINGS:
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On 03/05/2026 Licensing Program Analyst (LPA) Jacqueline Shaw-Ross made an unannounced visit to the facility to deliver the finding for the allegation noted above. LPA met with Barbara Bogoje, Executive Director and explained the purpose of the visit. The investigation consisted of interviews and records review.
On 04/28/2025, Community Care Licensing received a complaint alleging staff did not seek timely medical attention for resident.

Interview was conducted with the Executive Director (ED) Barbara Bogoje. During the interview, the ED stated that when a resident falls or slips, the caregiver checks on them, and if there is no complaint of pain and the resident can stand and walk without visible injuries, the facility will notify the resident’s doctor or family. The ED further explained that in memory care, medical attention is prioritized for fallen residents because they are often unable to communicate their needs.

Continue on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20250428151030
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: COTTAGES AT HEMET
FACILITY NUMBER: 331800055
VISIT DATE: 03/05/2026
NARRATIVE
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A review of records revealed that R1’s Physician Report with exam date of 08/15/2024, indicated cognitive impairment, dementia, confusion, and disorientation. The Physician’s Report, under category Able to Communicate Needs, it reads “unknown.” Facility charting notes were reviewed. The charting note dated 04/21/2025 revealed R1 was found on the floor in the hallway. Caregiver reports that R1 stated they did not hit their head and R1 was not complaining of pain or discomfort. Charting note dated 04/22/2025 revealed R1 was their normal self and was not complaining of pain or discomfort. Charting note dated 04/23/2025 revealed there were no complaints of pain or discomfort. Charting note dated 04/26/2025 revealed staff noted discoloration on R1’s left arm. The note further reads there no reports of R1 falling. This note has a time of 12:21pm. The next charting note dated 04/26/2025 with a time of 3pm, read R1’s arm was swollen and bruised and R1 was sent to the hospital.

An interview with medical staff who responded to the facility, reported that during their assessment of R1’s injuries, they observed bruising and swelling on the left arm. It was described as a purple and green bruise starting on the left arm, extending to the bicep, elbow and chest area of R1. The medical staff further reported R1 complained of pain but due to their cognitive condition, R1 could not explain what happened. They added that during checks for movement, R1 could not use their arm. Based on their medical experience, the injuries appeared to have occurred a couple of days prior, based on how much bruising was sustained.

R1’s medical records dated 04/26/2025 were reviewed, which revealed R1 was seen for an upper extremity injury. Medical records revealed a diagnosis of humeral fracture, possible c-spine fracture.

Therefore, the allegation is SUBSTANTIATED, which means the preponderance of evidence standard has been met.

A copy of this report along with 9099D, and Appeal Rights were provided to Executive Director, Barbara Bogoje.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20250428151030
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: COTTAGES AT HEMET
FACILITY NUMBER: 331800055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/19/2026
Section Cited
HSC
87465(g)
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The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).
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Licensee shall certify plan to address how the facility plans to remain in complaince with this regulation. Licensee will provide an in-service training to staff and to Med-techs to call 911 immediately when resident has any injury that requires medical attention that includes falls. Plan must be emailed to LPA Shaw-Ross by POC 03/19/2026.
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This requirement was not met as evidenced by: Licensee did not call 911 in a timely manner when immediate medical care was needed for R1's injuries.
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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: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20250428151030
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: COTTAGES AT HEMET
FACILITY NUMBER: 331800055
VISIT DATE: 03/05/2026
NARRATIVE
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An interview with the Executive Director, Barbara Bogoje, she reports there is not a policy on timely checks. She further reported that checks should be done every one to two hours. The Executive Director explained that caregivers do not document these checks. Interviews with caregivers revealed they check on residents every hour to hour and a half.

Records were reviewed. A review of R1’s Needs and Services Plan, with an effective date of 08/15/2024 was completed. The review revealed the plan was not signed by neither the resident, the resident’s responsible party nor a facility representative. The review of this document revealed relevant information under various categories. Under the category of Activities of Daily Living, it reads “Independent” and the note reads “uses walker outside of building”; under the category of Falls, it reads “No”; under the category of Ambulation, it reads “Independent”. A review of R1’s Physician Report with exam date of 08/15/2024, revealed R1 was able to independently transfer to and from the bed and was considered ambulatory for purposes of a fire clearance.

The investigation did not reveal that R1 was a fall risk or was on increased supervision checks. Therefore, the allegation is unsubstantiated, meaning the preponderance of evidence standard has not been met.

A copy of this report was explained and provided to Executive Director, Barbara Bogoje.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5