331800055-4-21-2026-18-AS-CTUA-DTMU9M-20260430152323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800055
Report Date: 04/21/2026
Date Signed: 04/21/2026 03:53:12 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
04/15/2026 and conducted by Evaluator Janette Romero

COMPLAINT CONTROL NUMBER: 18-AS-20260415152534

FACILITY NAME:	COTTAGES AT HEMET		FACILITY NUMBER:	331800055
ADMINISTRATOR:	BARBARA BOGOJE		FACILITY TYPE:	740
ADDRESS:	1177 S PALM AVE		TELEPHONE:	(951) 923-2844
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	110	CENSUS: 83	DATE:	04/21/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator Barbara Bogoje		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Staff did not administer Resident 1's medication as prescribed

INVESTIGATION FINDINGS:

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On 04/21/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced visit to the facility to investigate the allegation listed above. LPA met with Administrator Barbara Bogoje who was informed of the purpose of the visit.

LPA toured the facility with Administrator Bogoje, conducted interviews, and obtained copies of pertinent records. Regarding the allegation, "Staff failed to administer Resident 1's medication as prescribed" it was alleged that on 02/17/2026, R1 visited their physician and it was discovered that the facility failed to administer R1's medications as prescribed. It was reported that R1 resided in the facility until 02/14/2026. LPA made multiple unsuccessful attempts to contact the reporting party for additional information.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20260415152534

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: 04/21/2026

NARRATIVE

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LPA reviewed R1’s admission agreement dated 08/27/2025. Administrator confirmed that R1 moved out of the facility on 02/14/2026. LPA reviewed R1’s physician’s report dated 08/27/2025 documenting R1 exhibits memory loss and the “Able to Administer Own Prescription Medications”, “Able to Administer Own PRN Medications” and “Able to Store Own Medications” categories are marked “No”.

Administrator was interviewed and reported the following information. R1 was not prescribed any medications upon admission to the facility. While residing in the facility, R1 was prescribed routine medication which staff administered as prescribed. The facility has a contract with Yorba Linda Pharmacy (YLP) who is responsible for creating an electronic Medication Administration Record (MAR) profile for residents. Facility staff then use the electronic MAR to log the residents’ medication administration while residing in the facility. If a resident uses a different pharmacy, facility staff will fax YLP a request to profile the medication for MAR purposes only. If the resident is not listed in the electronic MAR, facility staff are responsible for generating a paper MAR until the resident’s electronic MAR is created by YLP. After a resident leaves the facility for thirty days, facility staff no longer have access to the resident's electronic MAR and are required to contact YLP to request a copy. Administrator contacted YLP to request a copy of R1’s electronic MAR for LPA’s review, but YLP staff was unable to locate a MAR profile for R1.

Two (2) of two (2) staff interviewed refuted the allegation and reported R1 received their medication as prescribed which was documented in R1’s electronic and paper MARs. Two (2) of two (2) staff interviewed reported observing multiple paper MARs on file for R1. However, administrator was only able to locate one (1) paper MAR from September 2025. Administrator was unable to locate a paper MAR for each medication prescribed to R1 during their stay in the facility. LPA was also unable to make contact with the facility's former memory care director or R1’s responsible person for an interview. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted and a copy of this report and Confidential Names list (LIC 811) was reviewed and provided to Administrator Bogoje.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2026

LIC9099 (FAS) - (06/04)

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