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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881106
Report Date: 01/06/2026
Date Signed: 01/06/2026 04:11:58 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
01/05/2026 and conducted by Evaluator Valerie Flores
COMPLAINT CONTROL NUMBER: 18-AS-20260105145548
FACILITY NAME:WELLQUEST OF MENIFEE LAKESFACILITY NUMBER:
331881106
ADMINISTRATOR:EADS, JONETTAFACILITY TYPE:
740
ADDRESS:29914 ANTELOPE RDTELEPHONE:
(951) 550-0500
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:151CENSUS: 127DATE:
01/06/2026
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Executive Director Eva TawfikTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Resident in care sustained unexplained injury due to staff neglect/lack of supervision
INVESTIGATION FINDINGS:
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On 1/6/2026, Licensing Program Analyst (LPA) Valerie Flores conducted an unannounced visit to the facility for the purpose of launching the complaint into the allegations listed above. LPA met with Executive Director Eva Tawfik and explained to Eva the purpose of the visit. The investigation consisted of records review, interviews, and observations.

Information received alleged that due to lack of supervision/staff neglect, Resident #1 (R1) sustained an unexplained injury to their right arm. Interviews with Staff #1 (S1) reported that during a brief change, S1 positioned R1 to R1’s left side in attempts to remove the brief from under R1. R1 reportedly became physically aggressive and threw their right arm back multiple times, attempting to strike S1. S1 reportedly stepped back to de-escalate the situation when S1 observed R1’s skin to be raised. S1 described the skin tear to be minor with very little to no blood protruding from the skin tear.
(Continue to LIC9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
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 2
Control Number 18-AS-20260105145548
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: WELLQUEST OF MENIFEE LAKES
FACILITY NUMBER: 331881106
VISIT DATE: 01/06/2026
NARRATIVE
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(Continuation of LIC9099)

Interviews with staff reported that S1 contacted Staff #2 (S2) via walkie talkie requesting a medium size bandage. Interviews with S2 and Staff #3 (S3) reported that S2 was unable to assist S1 and S3 was redirected to deliver the bandage to S1. Interview with S2 reported asking S1 of the severity of the injury and was advised by S1 that the injury was minor. Interview with S3 reported that when they delivered the bandage to S1, S3 did not assess the skin tear but noted that they did not observe R1 arm filled with blood like it was reported when Staff #4 (S4) discovered the injury. Interview with S1 reported that after they placed the bandage on R1, S1 continued changing R1’s brief, position R1 into R1’s preferred position in bed, covered R1 with a blanket, and exited the room. Interview with Staff #4 (S4) reported that during their rounds, S4 went into R1’s room to ask R1 if they were ready to go to dinner. S4 went to R1 to uncover the blanket off of R1 and observed R1 to have blood on R1’s right arm, briefs, and blanket. S4 went to Staff #5 (S5) to advise S5 of what they observed and S5 reportedly went to R1’s room to assess R1 then contacted emergency personnel. LPA attempted to interview R1 but interview was unsuccessful as R1 reports that they do not recall how they sustained the injury and suggested that they possibly hit their arm on the bedrail. A records review conducted of R1’s physician report details that R1 is combative at times, requires assistance with repositioning, incontinence care. A review of the residents care plan and assessment details that during brief changes/toileting tasks, R1 requires a two person assist. The assessment and care plan further detail that R1 has complex skin which increases the fragility of the skin. Through observations, LPA observed R1’s bedrails to be equipped with fabric covering and was advised by Staff #6 that the covers were implemented due to R1’s combative behavior as R1 sustained bruising in the past from the bedrail when exhibiting a behavioral episode. LPA further observed R1 to have gauze wrapped around their right forearm region but was unable to view the injury.
Due to insufficient evidence, the allegation of resident in care sustained unexplained injury due to staff neglect/lack of supervision is deemed unsubstantiated. A finding that the complaint is deemed unsubstantiated means that although the allegations may have occurred and/or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.
Through interviews and records review, LPA discovered a health and safety concern. A deficiency will be issued in accordance with Title 22 regulations.

A exit interview was conducted and a copy of this report was provided to Executive Director Eva Tawfik.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2