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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881421
Report Date: 12/17/2025
Date Signed: 12/17/2025 11:37:35 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
01/28/2025 and conducted by Evaluator Armando Perez
COMPLAINT CONTROL NUMBER: 18-AS-20250128082056
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: 8DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Caregiver Veronica JacksonTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff are not providing medication as prescribed
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 allegation. LPA met with Caregiver, Veronica Jackson, where the LPA explained the purpose of the visit and the elements of the allegation. The investigation included staff and witness interviews, as well as a review of records.

On January 28, 2025, Community Care Licensing received a complaint alleging that staff are not providing medication as prescribed. It was alleged medication was not being dispensed to Resident #1 as prescribed, including at appropriate times and dosage. Interview with Licensee Ma Satchel Lecita stated that R1 denies the medication and staff notated refusals on Medication Logs. The licensee reported she advised R1 to bring a ten-day supply of medication, however, R1 arrived with almost none. The licensee reported R1 did not have a primary physician upon admissions so they assisted R1 with locating a physician through R1’s provider.
Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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-20250128082056
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: 12/17/2025
NARRATIVE
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The licensee further stated that R1 refused follow-up visits and declined to provide any physician’s name, medical records, or information, insisting the licensee had no right to access such details. Interviews with 3 of 3 staff corroborated the licensee’s statements, reporting R1’s consistently refused to take prescribed medication and refused assistance with monitoring vitals to determine appropriate treatment for a restricted health condition, Interviews with staff revealed 3 of 3 emphasized that R1 would refuse medication because R1 thought the medication provided was incorrect. Furthermore, staff reported they complied with R1’s request to bring the medication bottles to R1 for review. However, R1 still continued to refuse.

Interview with R1 revealed they admitted to refusing medication, stating they believed it was incorrect. R1 further noted that they would not take medication without observing the dispensing bottle and verifying the medication themselves. R1 also emphasized that they did not recognize the color or shape of the medication, which caused concern and led to refusal. During the interview, R1 reported being advised by a physician not to take any medication prior to medical treatment related to their restricted health condition. R1 declined to provide the physician’s name.

An interview with Witness 1 (W1) was completed. W1 reported that R1 claimed facility staff were not providing the correct medication and did not recognize the medication being administered. W1 clarified that they did not personally observe the dispensing of medication and that their account was based solely on R1’s reports.

A review of records revealed Medication Administration Records (MAR) were maintained. Medical record logs indicated that R1 consistently refused prescribed medication, with staff recording each refusal.

Based on observation, record review, client, and staff interviews, the allegations staff are not providing medication as prescribed is 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 where a copy of this report was provided to facility representative.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2