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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881421
Report Date: 07/18/2025
Date Signed: 07/18/2025 03:23:42 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
07/12/2024 and conducted by Evaluator Abdoulaye Zerbo
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240712211908
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:
07/18/2025
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Edith CamposTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Staff did not ensure that resident's toileting needs were met
Staff did not ensure resident's medication was taken as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to deliver findings for the allegations listed above. LPA Abdoulaye was greeted and granted entrance by Caregiver Edith Campos. LPA Abdoulaye Zerbo identified himself and discussed the purpose of the visit.

It was alleged that staff did not ensure that resident's toileting needs were met . Concerns were raised that Resident 1 (R1) was left in soiled conditions for extended periods, resulting in rashes. During an interview, R1 reported being changed four to six times daily and whenever additional assistance was requested. Staff interviews confirmed this information. Further details revealed that R1 had appointments three to four times a week from 7 AM to 6 PM. Staff interviews also indicated that R1 was changed before leaving the facility and upon returning. However, it was noted that R1's diaper was not changed while away from the facility, which could explain the rash development. Information obtained from records review of diaper log revealed R1 was changed four to six times a day.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Abdoulaye Zerbo
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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 2
Control Number 18-AS-20240712211908
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: 07/18/2025
NARRATIVE
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A review of records corroborated that R1 was picked up by a transportation company contracted with R1’s insurance company for the first ten days of July 2024 and was hospitalized due to a urinary tract infection for the remainder of the month, during which the complaint was received by the department. Information obtained through interviews and records review could not verify R1 was left in soiled condition for a long period of time.

It was alleged Staff did not ensure resident's medication was taken as prescribed. Concerns were raised and staff were not providing R1 with their medication, which resulted in R1 having a seizure. LPA conducted interviews with facility representative, and information obtained revealed R1 medication was given as prescribed. Additional information obtained through records reviewed revealed R1 was not on seizure medication.

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: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2