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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800091
Report Date: 09/17/2025
Date Signed: 09/17/2025 02:02:09 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
04/20/2022 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20220420145745
FACILITY NAME:MONUMENT PARK MANORFACILITY NUMBER:
331800091
ADMINISTRATOR:G. CABANA & C. MAGISTRADOFACILITY TYPE:
740
ADDRESS:175 MUIR WOODS ROADTELEPHONE:
(951) 943-6403
CITY:PERRISSTATE: CAZIP CODE:
92570
CAPACITY:6CENSUS: 3DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
08:21 AM
MET WITH:Carlos MagistadoTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility does not provide a safe environment for resdient in care.
Staff member inappropriately handled resident in care.
INVESTIGATION FINDINGS:
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On 09/17/2025, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit at this facility. LPA met with staff, Noel Gonzalez, who contacted Administrator Carlos Magistrado, and the Licensee, who later joined the visit. LPA explained that the purpose of this visit is to complete the investigation and deliver the findings regarding the allegations mentioned above. LPA was granted access to the facility.
Investigation included: On 09/17/25, LP interviewed the Administrator (A1), the Licensee, three Residents (R4-R4), one staff member (S1), and two witnesses (W1), (W2). LPA review and obtained the following documents: Resident roster, personnel roster, service records for (S1), facility staff in-service trainings, and other relevant records related to this complaint, including (R1’s) Admission Agreement (dated 02/06/22), Identification And Emergency Information (dated 02/06/22), Physician Report LIC 602A (dated 02/07/22), Needs of Service Plan (dated 02/10/22), And Physician Report for Residents #2-4 (R2-R4) (dated 02/02/, 06/07, 10/09/24).
Evaluation Report continues LIC 9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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 5
Control Number 18-AS-20220420145745
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: MONUMENT PARK MANOR
FACILITY NUMBER: 331800091
VISIT DATE: 09/17/2025
NARRATIVE
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Allegation #1: Facility does not provide a safe environment for residents in care.

The complaint alleges that residents feel unsafe living at the facility. On September 17, 2025, between 9:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Administrator, who denied the allegation and stated that the facility has staff available 24 hours a day from Monday to Sunday. The Administrator also mentioned that two caregivers are assigned to assist Resident 1 (R1) at all times.

On the same day, the LPA interviewed the Licensee during the same time frame, who also denied the allegation. Additionally, three residents (R2-R4) were interviewed between 9:00 AM and 11:00 AM. They all denied feeling unsafe and expressed that they feel secure living at the facility, noting that staff are always present to assist them.

On September 17, 2025, between 9:00 AM and 11:00 AM, the LPA interviewed Staff Member #1 (S1), who denied the allegations. S1 stated that the facility has a 24-hour caregiver available. S1 mentioned that when S1 worked at night, they checked on the residents before bedtime and during the night to ensure that everyone was okay.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20220420145745
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: MONUMENT PARK MANOR
FACILITY NUMBER: 331800091
VISIT DATE: 09/17/2025
NARRATIVE
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Additionally, on September 17, 2025, between 9:00 AM and 11:00 AM, the LPA interviewed Witness #1 (W1), who also denied the allegations, affirming that the facility provided a safe environment for Resident #1 (R1). Later, at 12:30 PM on the same day, the LPA interviewed Witness #2 (W2), who similarly denied the allegations, reiterating that the facility ensured a safe environment for R1. W2 explained that R1 did not return to the facility because R1 required a higher level of care following hospitalization. Unfortunately, the LPA was unable to interview R1 due to R1’s passing in April 2023.

On September 17, 2025, records reviewed by LPA regarding employee schedules (dated July 30, August 30, and September 30, 2025) indicated that residents receive care and supervision 24 hours a day, every day of the week. Additionally, the LPA reviewed records of employee fire drills and emergency drills conducted between January 30 and April 15, 2025. During the visit on September 17, the LPA observed that the residents were very active and interacted with the administrator, licensee, and staff with laughter.

Based on the information collected, record reviews, and interviews, the department found no evidence to support the allegation mentioned in this complaint. 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 that the facility does not provide a safe environment for residents in care is Unsubstantiated.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20220420145745
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: MONUMENT PARK MANOR
FACILITY NUMBER: 331800091
VISIT DATE: 09/17/2025
NARRATIVE
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Allegation #2: Staff members inappropriately handled residents in care.

The complaint alleges that a staff member was torturing the client by punishment, by having the client lie at the edge of the bed. On September 17, 2025, between 09:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Administrator (A1), who denied the allegation. A1 stated that the client never mentioned that any of that had happened. A1 emphasized that all staff receive training in residents' rights and that any staff member found to have violated a Resident’s rights would be terminated immediately, regardless of the circumstances.

On September 17, 2025, between 9:00 AM and 11:00 AM, the Licensing Program Analyst (LPA) interviewed the Licensee, who denied the allegations. During the same time period, the LPA also interviewed three residents (R2-R4), all of whom denied the allegations and stated that the staff had never mishandled or punished them. They described the staff as always being very nice and helpful.

Additionally, the LPA interviewed one staff member (S1) between 9:00 AM and 11:00 AM, who also denied the allegations. S1 emphasized that residents have rights and that staff should never mishandle or punish them. At 12:30 PM on the same day, the LPA interviewed a witness (W1), who likewise denied the allegations, asserting that the facility did not mishandle Resident 1 (R1) and that R1 was very happy living there. Another witness (W2) confirmed during their interview that the facility took good care of R1, explaining that R1 did not return to the facility because R1 required a higher level of care.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20220420145745
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: MONUMENT PARK MANOR
FACILITY NUMBER: 331800091
VISIT DATE: 09/17/2025
NARRATIVE
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It is important to note that the LPA was unable to interview R1 due to R1's passing in April 2023. On September 17, 2025, the LPA reviewed staff training records, which included: 20 Hours of Caregiver Training (dated 01/30/25), Catheter Care, Wound Care (dated 01/30/25), Employee Orientation Training, Aging Progress, Physical Needs, Resident Rights (dated 06/09/25). On 09/17/25, the LPA observed that the residents were very active and interacted with the Administrator, Licensee, and staff with laughter.

Based on the information collected, record reviews, and interviews, the department found no evidence to support the allegation mentioned in this complaint. 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 staff member inappropriately handled the resident in care is Unsubstantiated.

No deficiencies cited.

An exit interview was conducted. A copy of this report was provided to the Administrator, Carlos Magistrado.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5