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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800490
Report Date: 02/11/2025
Date Signed: 02/11/2025 10:51:50 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/10/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250110085626
FACILITY NAME:VILLA DESCANSO SENIOR LIVINGFACILITY NUMBER:
331800490
ADMINISTRATOR:TORRES, GABRIELAFACILITY TYPE:
740
ADDRESS:6683 LEANNE STREETTELEPHONE:
(909) 332-0311
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:6CENSUS: 6DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Staff Memeber- Joaquin ThompsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff mistreated a resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with staff member Joaquin Thompson and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record review.

For the allegation, Staff mistreated a resident while in care.

During staff interviews, 4 out of the 5 staff stated they have witness S1 yell at their residents. In addition, S1 admitted they have yelled at R1. During residents interviews, 3 out of the 4 residents stated they have been yelled by S1.

Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/10/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250110085626

FACILITY NAME:VILLA DESCANSO SENIOR LIVINGFACILITY NUMBER:
331800490
ADMINISTRATOR:TORRES, GABRIELAFACILITY TYPE:
740
ADDRESS:6683 LEANNE STREETTELEPHONE:
(909) 332-0311
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:6CENSUS: 6DATE:
02/11/2025
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Staff member- Joaquin ThompsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff inappropriately grabbed and pulled a resident's ear while in care.
INVESTIGATION FINDINGS:
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5
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13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with staff member Joaquin Thompson and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record review.

For the allegation, Staff inappropriately grabbed and pulled a resident's ear while in care.

During staff interviews, 5 out 5 staff stated they have not pulled resident’s ear while in care and have not witness a staff member pull resident's ear. During resident interviews 4 out of the 4 residents stated no staff member has pulled their ears.

Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
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 6
Control Number 56-AS-20250110085626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
VISIT DATE: 02/11/2025
NARRATIVE
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A finding that the complaint are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to staff member Joaquin Thompson.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 56-AS-20250110085626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/12/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)(3) Personal Rights of Residents in All Facilities (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as.. interfering with daily living functions such as eating, sleeping, or elimination.
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Administrator stated they will train their staff on the regulation cited and will send confirmation to LPA Rico.
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Based on interviews, the Licensee did not comply with the section cited above by not ensuring residents are free from punishment, and intimidation which poses an immediate health, safety and personal rights risks to residents in care.
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POC due date 2/12/2025
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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: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20250110085626
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
VISIT DATE: 02/11/2025
NARRATIVE
1
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A finding that the complaint are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to staff member Joaquin Thompson. along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6