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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530157
Report Date: 09/25/2025
Date Signed: 09/25/2025 04:20:06 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
03/11/2025 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250311155200
FACILITY NAME:AMISTAD ASSISTED LIVING AND MEMORY CARE HOMEFACILITY NUMBER:
335530157
ADMINISTRATOR:GARCIA, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:2308 MAVERICK CIRCLETELEPHONE:
(951) 310-4622
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:6CENSUS: 2DATE:
09/25/2025
UNANNOUNCEDTIME BEGAN:
12:41 PM
MET WITH:Administrator - Christopher Garcia TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility staff left resident in soiled clothing for an extended period of time.
Facility staff are not meeting residents toileting needs.
Facility staff leave resident in soiled bedding.
Facility staff are not assisting resident with personal hygiene.
Facility staff are mismanaging resident's medication.
Facility staff changed their visitor hours policy.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings regarding the allegations listed above. LPA met with Administrator Christopher Garcia and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and a review of facility records.

For the allegation, Facility staff left residents in soiled clothing for an extended period of time. During staff interviews, the Administrator admitted that they had been unable to change Resident 1 (R1) for over sixteen hours. During the facility tour, LPA Rico observed R1 wearing soiled clothing.

For the allegation, Facility staff are not meeting residents' toileting needs. During staff interviews, the Administrator stated they have not been able to meet residents' toileting needs. The Administrator reported that R1’s brief is only changed when hospice staff provide showers. Based on record review the facility staff are incompetent to provide care for R1, LPA found that facility staff had not completed training
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
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 5
Control Number 56-AS-20250311155200
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: AMISTAD ASSISTED LIVING AND MEMORY CARE HOME
FACILITY NUMBER: 335530157
VISIT DATE: 09/25/2025
NARRATIVE
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related to assisting with Activities of Daily Living (ADLs) and did not have a copy of R1 care plan to meet their medical and dental needs.

For the allegation, Facility staff leave residents in soiled bedding. During staff interviews, the Administrator stated that they wash residents’ bedding, it often becomes soiled again due to residents wearing soiled clothing. During the facility tour, LPA observed wet bedding and a soiled bedding in the living room couch.

For the allegation, Facility staff are not assisting residents with personal hygiene. All staff interviewed stated they have been unable to assist R1 with personal hygiene due to R1’s behaviors. Based on record review the facility staff are incompetent to provide care for R1, LPA found that facility staff had not completed training related to assisting with Activities of Daily Living (ADLs) with residents with dementia.

For the allegation, Facility staff are mismanaging residents' medication. During a medication audit, LPA observed that R1’s PRN medication was not documented on R1’ MAR, that would include resident’s response, reason for administration, and date/time. Additionally, LPA observed loose medication in R1’s container box without original packaging. During staff interviews, the Administrator admitted that PRN medication documentation had not been completed and were unaware of loose medication.

For the allegation, Facility staff changed their visitor hours policy. During the facility tour and record review, LPA observed that the posted visitor hours were 11:00 a.m. to 5:00 p.m., which did not match the facility’s approved Plan of Operation submitted to Community Care Licensing. The original visitor hours were listed as 10:00 a.m. to 7:00 p.m. During staff interviews, the Administrator admitted to changing the facility’s visitor hours.

Based on the evidence gathered during today’s investigation, the six (6) 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, six (6) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D were discussed and provided to Administrator Christopher Garcia, along with a copy of the appeal rights.

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

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20250311155200
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: AMISTAD ASSISTED LIVING AND MEMORY CARE HOME
FACILITY NUMBER: 335530157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities:
(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents.. personal rights: (4) To care, supervision, and services that meet...their needs. This requirement is not met as evidenced by:
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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
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Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.
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Under Appeal
Type A
09/26/2025
Section Cited
CCR
87468.1(a)(1)
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87468.1(a)(2) Personal Rights of Residents in All Facilities:
(a) Residents in all residential care facilities for the elderly shall have all.. rights:(2) To be accorded safe, healthful and comfortable.. equipment. This requirement is not met as evidenced by:
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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
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Based on interviews and record review, the Administrator did not comply with the section cited above by not providing safe, healthful, and comfortable accomodations to the residents which poses an immediate health, safety or personal rights risk to persons in care.
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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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20250311155200
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: AMISTAD ASSISTED LIVING AND MEMORY CARE HOME
FACILITY NUMBER: 335530157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87303(a)
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87303Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date.
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Based on interviews and record review, the Administrator did not comply with the section cited above by not providing clean bedding which poses an immediate health, safety or personal rights risk to persons in care.
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POC due 9/26/2025
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87705(1)(A)
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87705 (1)(A)Care of Persons with Dementia(1)(A)Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication,.. activities, behavioral challenges, the environment, and assisting with activities of daily living;

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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff will also complete their dementia training.
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Based on interviews and record review, the Administrator did not comply with the section cited above by not providing care, supervision, services to meet the residents needs which poses an immediate health, safety or personal rights risk to persons in care.
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POC due 9/26/2025
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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20250311155200
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: AMISTAD ASSISTED LIVING AND MEMORY CARE HOME
FACILITY NUMBER: 335530157
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87465(d)(3)
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87465 Incidental Medical and Dental Care
(d)(3) The date and time the PRN medication was taken, the dosage taken, and the resident's response shall be documented and maintained in the resident's facility record.
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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff complete an in-service training.
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Based on interviews and record review, the Administrator did not comply with the section cited above by documenting R1's PRN which poses an immediate health, safety or personal rights risk to persons in care.
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POC due date 9/26/2025
Under Appeal
Type A
09/26/2025
Section Cited
CCR
87208(a)
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87208Plan of Operation(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing..
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Administrator stated that he will review the regulation cited and submit a statement of understanding to LPA via email by POC due date. The facility staff post their approved visitor hours.
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Based on interviews and record review, the Administrator did not comply with the section cited above by changing visitor hours which poses an immediate health, safety or personal rights risk to persons in care.
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POC due date 9/26/2025
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: 09/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5