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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880585
Report Date: 09/30/2025
Date Signed: 09/30/2025 12:48:13 PM

Substantiated


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
07/22/2022 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 18-AS-20220722113442
FACILITY NAME:COOL MEADOW CAREFACILITY NUMBER:
331880585
ADMINISTRATOR:MA SATCHEL LECITAFACILITY TYPE:
740
ADDRESS:29787 COOL MEADOW DRTELEPHONE:
(951) 246-0214
CITY:MENIFEESTATE: CAZIP CODE:
92587
CAPACITY:6CENSUS: 6DATE:
09/30/2025
UNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Long ZhangTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff restrained resident.
INVESTIGATION FINDINGS:
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On 9/30/25, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations, and to deliver findings. The Department was met by Administrator Long Zhang and the purpose of the visit was explained.

Investigation consisted of the following:
On 7/26/22, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegation mentioned above. It was determined that the complaint required further investigation.
On 9/16/25, the Department made a subsequent visit and interviewed the Administrator(A1) and 2 staff (S1-S2) who were present at the time of visit. The Department also conducted 3 resident interviews (R2-R3). R1 no longer lives at the facility. R1 remained at facility until her passing on 12/30/23. R1’s date of admission was 5/15/2022.
On 09/16/25 The Department obtained and reviewed the following documents: Staff roster (dated 3/19/24), resident roster (6/1/25), physician’s order for wheelchair safety seat restraints (date 7/14/22), Employee training record. The Department reviewed Residents (R2-R4) file.
On 9/23/25, the Department obtained via email copy of R1’s incident/death report (dated 12/20/23).

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
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 4
Control Number 18-AS-20220722113442
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: COOL MEADOW CARE
FACILITY NUMBER: 331880585
VISIT DATE: 09/30/2025
NARRATIVE
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Investigation revealed the following:

Allegation: Staff restrained resident.

The detail of the complaint alleges that "Witness #1 (W1) made an unannounced visit to this facility on 2 different occasions and witnessed a resident restrained.”

On 9/16/25 at 11:00am, the Department interviewed the Administrator (A1) regarding the above allegation. A1 denied the allegation, stating that he was not the Administrator during the time of incident but pointed out that there was a doctor’s order for a wheelchair restraint for R1.

On 9/16/25, between 9:00am and 11:00am, the Department interviewed 2 staff regarding the above allegation, and of those interviewed 1 out of 2 were hired after the alleged incident occurred. 1 out of 2 stated that she was at the facility during that time and stated that there was a doctor’s order in place for a wheelchair restraint. However, 1 of the 2 staff interviewed admitted to using a “handmade” restraint to keep R1 from falling out of her wheelchair. Both staff stated that they are aware of the residents’ rights and know that a resident should not be restrained unless there is a doctor’s order such as a wheelchair restraint for safety.

On 9/16/25, between 9:00 and 11:30am The Department interviewed 3 residents (R2-R4) regarding the above allegation. Of those interviewed 3 out of 3 stated that they have never been restrained at any time, stated that their rights are respected and they feel safe at the facility.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20220722113442
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: COOL MEADOW CARE
FACILITY NUMBER: 331880585
VISIT DATE: 09/30/2025
NARRATIVE
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On 9/16/25, The Department obtained, reviewed and evaluated the following pertinent documents: Staff training: Resident Rights (dated 1/18/19) and Physician’s Order for R1’s wheelchair restraint (dated 7/13/22 and signed by doctor on 7/14/22, which indicates a request for wheelchair safety seat restraint to prevent from fall/injury was granted.

On 9/23/25, the Department obtained via email and reviewed copy of R1’s incident/death report (dated 12/20/23).

Based on LPAs interviews and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

California Code of Regulations, Title 22, Division (6) and Chapter (8) is being cited on the attached LIC 9099D.

Exit interview conducted and copy of report and appeals rights provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20220722113442
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: COOL MEADOW CARE
FACILITY NUMBER: 331880585
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/01/2025
Section Cited
CCR
87608(a)(1-5)
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Postural Supports(a) Based on the individual's preadmission appraisal, and subsequent changes…the facility shall provide assistance and care for the resident in those activities… resident is unable to do for himself/herself. Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include tying, depriving, or limiting the use of a resident's hands or feet.
This requirement is not met as evidence by:
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Residents will not be restrained unless all requirements of Section 87608 are met.
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R1 was observed to be restrained on two different occasions (9/12/22 & 9/13/22) using a handmade restraint limiting the use of R1’s ability to move. S1 admitted during the interview conducted on 9/16/25 that she had used a homemade belt made from a bed fitted sheet on R1’s wheelchair.
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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: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4