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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530171
Report Date: 10/23/2025
Date Signed: 11/20/2025 04:34:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
08/12/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20250812162509
FACILITY NAME:WILDOMAR SENIOR ASSISTED LIVINGFACILITY NUMBER:
335530171
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:32365 SOUTH PASADENA STTELEPHONE:
(323) 902-6000
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:200CENSUS: 114DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Theresa Gamez, Assistant Executive DirectorTIME COMPLETED:
06:15 PM
ALLEGATION(S):
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Facility does not ensure that staff are awake on the premises
Facility staff inappropriately speak to residents
Facility pipes are in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Theresa Gamez, Assistant Executive Director and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents.

The allegation that facility does not ensure that staff are awake on the premises. Ten (10) residents stated that they have not seen staff asleep on the premises. One (1) resident stated that a few months ago, they seen 2 night staff sleeping on the premises. Four (4) staff interviewed denied sleeping on the premises during work hours. Seven (7) staff interviewed stated that they have not seen a staff sleeping on the premises during work hours.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
08/12/2025 and conducted by Evaluator Becky Mann
COMPLAINT CONTROL NUMBER: 56-AS-20250812162509

FACILITY NAME:WILDOMAR SENIOR ASSISTED LIVINGFACILITY NUMBER:
335530171
ADMINISTRATOR:KAREN ROPERFACILITY TYPE:
740
ADDRESS:32365 SOUTH PASADENA STTELEPHONE:
(323) 902-6000
CITY:WILDOMARSTATE: CAZIP CODE:
92595
CAPACITY:200CENSUS: 114DATE:
10/23/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Theresa Gamez, Assistant Executive DirectorTIME COMPLETED:
06:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not providing adequate care and supervision to residents in care
Facility staff are not ensuring the facility is free of vermin
INVESTIGATION FINDINGS:
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The allegation that facility staff are not providing adequate care and supervision to residents in care. Six (6) residents interviewed stated that staff do not respond to the call button in a timely manner. Three (3) residents stated that they were left soiled in their pulls up for a few hours. Four (4) staff interviewed stated that they do provide adequate care and supervision to the residents.
The allegation that facility staff are not ensuring the facility is free of vermin. Four (4) residents interviewed stated that they did have bed bugs in their room a few months ago. Based on LPA observations, interviews, and record reviews of the exterminator invoices, there were bed bugs present at the facility, so the exterminator made monthly visits for the treatment of bed bugs.

The above allegations is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and a copy of this report was provided to Theresa Gamez, Assistant Executive Director at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20250812162509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING
FACILITY NUMBER: 335530171
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/23/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/30/2025
Section Cited
HSC
87625(b)(3)
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87625 Managed Incontinence
(b)addition Section 87611, General Requirements for licensee shall be responsible for: (3)Ensuring incontinent residents are kept clean, dry and facility remains free of odors from incontinence. Requirement has not been met:
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Licensee will submit a Statement of Understanding and training with staff signatures to LPA by Plan of Correction (POC) due date
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Based on LPA interviews, Licensee did not ensure that residents are being changed in a timely manner. Which poses a potential health and safety concern for residents in care.
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Type B
11/27/2025
Section Cited
HSC
87303(a)
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87303 Maintenance and Operation (a) 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…this requirement is not met as evidenced by:
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Licensee shall provide training on how to treat and prevent bed bugs to all staff. Licensee shall submit proof of training to the LPA by Plan of Correction (POC) due date.
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Interviews with staff, residents, and document reviews reveal that the facility did have bed bugs. This poses a potential health and safety risk to residents 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: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 56-AS-20250812162509
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING
FACILITY NUMBER: 335530171
VISIT DATE: 10/23/2025
NARRATIVE
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The allegation that facility staff inappropriately speak to residents. Eight (8) out of ten (10) residents stated that staff have not spoken to residents inappropriately. Seven (7) staff denied speaking to residents inappropriately.

The allegation that facility pipes are in disrepair. Based on LPA observations, the facility have fixed the pipes that are in disrepair. LPA observed and did a record review of receipts and invoices of repairs for the pipes from the company Apex Plumbing Services Inc. The facility has continued to repair the pipes in a timely manner.

Based on evidence obtained during this investigation, the allegations above are Unsubstantiated; meaning that 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.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Theresa Gamez, Assistant Executive Director at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Becky Mann
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4