331881421-7-28-2025-18-AS-JDHS-DK4VZF-20250731165237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881421
Report Date: 07/28/2025
Date Signed: 07/28/2025 11:33:07 AM

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
05/28/2025 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20250528091327

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: 9	DATE:	07/28/2025
		UNANNOUNCED	TIME BEGAN:	10:53 AM
MET WITH:	Administrator Ma Satchel Lecita		TIME COMPLETED:	11:42 AM

ALLEGATION(S):

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Facility staff hit resident
Facility staff are not providing adequate food service
Facility staff are not dispensing medications as precribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Armando Perez, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Ma Satchel Lecita, where the LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of interviews with staff and residents, and a review of records.

On May 28, 2025, Community Care Licensing received a complaint alleging facility staff hit resident, facility staff are not providing adequate food service and facility staff are not dispensing medications as prescribed.

It was alleged Resident 1 (R1) was physically assaulted by a male facility staff member. Resident interviews were conducted. The interviews revealed a male staff entered the room and began striking R1 for being too loud. It was reported there was a witness (W1) to the incident.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025

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-20250528091327

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: 07/28/2025

NARRATIVE

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A name was provided for the staff however, that name did not match any staff employed at the facility. However, based on the description of the staff provided, the LPA was able to determine the allegation involved Staff 1 (S1).

An interview with W1 contradicted the account of their witnessing the incident by disclosing they never witnessed any physical abuse by S1 towards R1. This interview also revealed S1 being described as kind and respectful. Resident interviews were conducted where, 4 of 5 indicated no prior observations or experience of physical aggression by S1. The remaining interview, 1 of 5, did not recall a male staff member working. The administrator was interviewed. The administrator reported they learned of the incident and when they spoke to R1, the administrator reports R1 retracted the statement and reported confusion about the incident. The administrator reported that S1 denied physically assaulting R1. S1 was interviewed and reported S1 encountered R1 on the day of the incident. S1 said R1 was yelling, they entered the room and noticed what they described as white foam coming from R1’s mouth. S1 described trying to wipe the foam and R1 moving their head back. S1 denied physically assaulting R1.

It was alleged that staff was not providing adequate food service. The allegations included R1 being served last during meal services, not being provided food upon return to the facility and a witness overhearing staff say they ran out of food.

Further details about the day R1 returned to the facility and was not provided food included that a third party brought outside food for R1. R1 had already returned to the facility when the third party brought the food. Staff interviews revealed 3 of 3 staff did not recall that specific incident, however, the interviews revealed R1 was provided meals at all meal times. The witness who overheard the statement about the facility running out of food, could not provide details on the staff who made the statement. Residents were interviewed, including R1. R1 reported they had no complaints regarding food service. It was reported meal portions were adequate and they received additional servings when requested. The additional resident interviews were conducted where 5 of 5 affirmed they regularly received meals with adequate portions and noted that staff provided additional servings upon request.

It was alleged that facility staff failed to dispense medications according to prescribed instructions.
Continued on LIC 9099-C.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20250528091327

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: 07/28/2025

NARRATIVE

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Administrator stated that 9 of 13 medications were delivered to the facility on April 25, 2025 by R1’s responsible party. The administrator reports speaking to R1’s responsible party who informed them that the remaining medications were pending insurance approval.

The conflict arises where it is being alleged that the remaining medications were delivered directly to the facility. However, the administrator denies receiving the additional medications. Interviews with relevant parties did not reveal any corroborating evidence regarding the delivery of the medications. It is unknown which medications or on what date they were delivered. A review of R1’s Medication Administration Record (MAR) showed that 9 medications were dispensed between April 25, 2025, and May 22, 2025. Additionally, the MAR revealed that on May 15, an extra medication was prescribed and added to the nighttime regimen. An interview with R1 confirmed they received their medications as prescribed. Additional resident interviews revealed, 6 out of 6 residents reported receiving medication as prescribed and do not have concerns with dispensing of medication.

Based on interviews and record reviews, the allegations staff hit resident, not providing adequate food and not dispensing medications as prescribed is deemed unsubstantiated. A finding that the complaint is unsubstantiated means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted. A copy of this report was provided to the Administrator, Ma Satchel Lecita.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2025

LIC9099 (FAS) - (06/04)

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