<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530078
Report Date: 07/22/2025
Date Signed: 07/22/2025 12:15:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/08/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250708095846
FACILITY NAME:RESSA RESIDENTIAL CAREFACILITY NUMBER:
335530078
ADMINISTRATOR:ANGELES, ARIELFACILITY TYPE:
740
ADDRESS:30002 NORTH LAKE DRTELEPHONE:
(951) 674-4572
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:6CENSUS: 4DATE:
07/22/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator - Ariel AngelesTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff refused to take resident back into care.
Unlawful eviction.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Ariel Angeles and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record reviews.

For the allegation, Staff refused to take resident back into care. On 7/3/2025 the hospital attempted to return R1 back to the facility, Administrator admitted they did not accept R1 back to the facility due to behaviors. Per staff interviews, S2 confirmed the Administrator did not accept R1 back to the facility.

For the allegation, Unlawful eviction. Per interviews, the Administrator informed LPA that they did not provide a 30-Day Notice Eviction to R1. The Administrator indicated that R1 was not an official resident. Based on record review, R1 had signed the pre-admission agreement and was charged five hundred dollars. Furthermore, R1 was charged and an additional five-hundred dollars for his two night stay, a total of one thousand dollars.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
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 56-AS-20250708095846
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: RESSA RESIDENTIAL CARE
FACILITY NUMBER: 335530078
VISIT DATE: 07/22/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During resident interviews, R1 confirmed that one thousand dollars was withdrawn from their bank account for their two night stay. LPA received a copy of R1’s bank receipt and confirmed the one thousand dollars was withdrawn. In addition, LPA observed that no 30-Day Eviction Notice was sent to Community Care Licensing.

Based on the evidence gathered during today’s investigation, the two (2) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because of the preponderance of evidence the standard has been met.

During today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Ariel Angeles along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250708095846
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: RESSA RESIDENTIAL CARE
FACILITY NUMBER: 335530078
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2025
Section Cited
CCR
87468(a)(20)
1
2
3
4
5
6
7
87468(a)(20)To be protected from involuntary transfers, discharges, and evictions.. state.. and relocation protections for residents. For purposes of this paragraph.. means a transfer, discharge, or eviction that is initiated by the licensee, not by the resident
1
2
3
4
5
6
7
The Administrator stated they will read the regulation cited 87468(A)(20) and will send a self-verification letter they have read and understood the regulation.
8
9
10
11
12
13
14
This requirement wasn't met as evidenced by: Based on interviews, the Administrator did not accept R1 back to the facility which poses an immediate health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
POC due date 7/23/2025
Type A
07/23/2025
Section Cited
CCR
87224(a)(2)
1
2
3
4
5
6
7
87224(a)(2) Eviction Procedures... (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph (5)....
1
2
3
4
5
6
7
Administrator has agreed to review the entire Eviction Procedures regulation and complete a statement of understanding and provide a signed and dated copy to LPA Rico
8
9
10
11
12
13
14
This standard wasn't met as evidenced by:Based on interviews, observation and record review, the licensee did not provide R1 and 30-Day Eviction Notice which poses an immediate Health, Safety or Personal Rights risk to persons in care.
8
9
10
11
12
13
14
POC due date 7/23/2025
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: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3