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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881421
Report Date: 01/31/2025
Date Signed: 01/31/2025 05:16:48 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
01/15/2025 and conducted by Evaluator Janette Romero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250115150201
FACILITY NAME:SMITH ROAD ASSISTED LIVINGFACILITY NUMBER:
331881421
ADMINISTRATOR:LECITA, MA SATCHELFACILITY TYPE:
740
ADDRESS:753 SMITH ROADTELEPHONE:
(951) 927-8178
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:12CENSUS: 9DATE:
01/31/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Licensee, Ma Satchel LecitaTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Unlawful eviction.
INVESTIGATION FINDINGS:
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On 1/31/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to deliver findings regarding the allegation listed above. LPA met with Caregiver, Juana Gonzalez who was informed of the purpose of the visit. Licensee, Ma Satchel Lecita arrived during the visit and was also informed of the purpose of the visit.

Regarding the allegation, "Unlawful eviction" it was alleged that Resident 1 (R1) was given an eviction notice for non-compliance of house rules, but was not provided supporting facts of these concerns. Records reviewed indicated R1 was provided with a written eviction notice on 12/30/2024, which did not contain specific required facts including dates, places, witnessess and circumstances related to non-compliance of house rules. Licensee was interviewed and reported the supporting information was not provided to R1 in the eviction notice. Consultation of eviction regulations was provided to Licensee. Licensee has now expressed understanding of the regulatory requirements to evict a resident.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
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 3
Control Number 18-AS-20250115150201
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: SMITH ROAD ASSISTED LIVING
FACILITY NUMBER: 331881421
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/31/2025
Section Cited
CCR
87224(d)
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(d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement was not met as evidenced by:
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Licensee reported they will rescind the 12/30/2024 eviction letter provided to R1 by 02/01/2025 and submit proof of correction to the Department by close of business 02/03/2025.
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Based on record review of R1's eviction, the licensee did not provide R1 with specific facts related to the reasons for eviction notice. R1's eviction lacked informative dates, places, witnesses, and/or circumstances related to alleged violations of the house rules. Licensee was interviewed and reported the supporting information was not provided to R1 in the eviction notice. This poses a potential health, safety, and personal rights risk to residents in care.
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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: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250115150201
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: SMITH ROAD ASSISTED LIVING
FACILITY NUMBER: 331881421
VISIT DATE: 01/31/2025
NARRATIVE
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Licensee reported they will rescind the 12/30/2024 eviction letter provided to R1 by 02/03/2025 and submit proof to the Department by close of business 02/03/2025. Licensee was notified that she is not prohibited from issuing another eviction letter to R1 as long as it met regulatory requirements. Based on interviews conducted and records reviewed, 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, Chapter 8), is being cited on the attached LIC 9099-D. An exit interview was conducted, and a copy of this report was provided. An exit interview was conducted and a copy of this report was reviewed and provided to Licensee along with LIC 9099-D, Confidential Names list (LIC 811), and Appeal Rights.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3