331881421-5-21-2025-18-AS-APAO-DJW7LM-20250724214546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881421
Report Date: 05/21/2025
Date Signed: 05/21/2025 05:10:01 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
06/11/2024 and conducted by Evaluator Abdoulaye Zerbo

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240611165807

FACILITY NAME:	SMITH ROAD ASSISTED LIVING		FACILITY NUMBER:	331881421
ADMINISTRATOR:	LECITA, MA SATCHEL		FACILITY TYPE:	740
ADDRESS:	753 SMITH ROAD		TELEPHONE:	(951) 927-8178
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	12	CENSUS: 11	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Veronica Jackson		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Licensee is not allowing resident to phone calls.
Licensee does not allow resident to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced subsequent visit for additional investigation into the allegations listed above. LPA Abdoulaye was greeted and granted entrance by staff Veronica Jackson. LPA Abdoulaye Zerbo identified himself and discussed the purpose of the visit.

It was alleged Staff did not allow resident to make and receive phone calls. Concerns were raised regarding staff not allowing residents to receive or make phone calls. During today’s visit, LPA observed a working phone in the office area and accessible to residents. LPA conducted interviews with multiple residents and information obtained revealed residents are allowed to use the phone and receive phone calls from family members, witnessed by R2 receiving a phone call at 12:45pm. Further information obtained revealed for residents unable to access the phone, staff will take the phone to them when requested.
Continued 9099-C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240611165807

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: 05/21/2025

NARRATIVE

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It was alleged Staff does not allow resident to have visitors. LPA reviewed resident’s record, facility file and visitation log. The information obtained revealed the Resident 1 (R1) received visitation for the month of May 2024 and June 2024 but not from a confidential witness. Interviews were conducted and information received revealed the confidential witness refused to sign visitation log and brings food items for R1 who has a modified diet, which constituted a violation of the facility’s visiting policy. Further information received from interviews revealed confidential witness visited the facility about three (3) times between 06-07-24 to 07-07-24 during the R1’ s stay at the facility. During those visits, the confidential witness had altercations with staff members and law enforcement was called on 06-14-24 and the confidential witness was told to vacate the premises by law enforcement officers. LPA conducted interviews with residents and staff and information obtained corroborated that all residents are allowed to have visitors, and the visiting hours are posted on the front door.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Administrator Ma Satchel Lecita

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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