335530171-3-27-2026-56-AS-EMAN-DTDTB5-20260422143434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 335530171
Report Date: 03/27/2026
Date Signed: 03/27/2026 02:35:04 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
03/20/2026 and conducted by Evaluator Hannah Rodgers

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260320143116

FACILITY NAME:	WILDOMAR SENIOR ASSISTED LIVING		FACILITY NUMBER:	335530171
ADMINISTRATOR:	KAREN ROPER		FACILITY TYPE:	740
ADDRESS:	32365 SOUTH PASADENA ST		TELEPHONE:	(323) 902-6000
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	200	CENSUS: 113	DATE:	03/27/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Executive Director Karen Roper & Assistant Executive Director Theresa Gamez		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Hannah Rodgers conducted an unannounced visit to initiate and deliver findings regarding the above complaint allegation. LPA introduced herself and disclosed the purpose of the visit to Executive Director Karen Roper and Assistant Executive Director Theresa Gamez.

On March 20, 2026, it was alleged that staff mismanaged resident's medication. According to the allegation received, on March 19, 2026, Resident #1 (R1) was not given two of their prescribed medications and since that incident R1 no longer receives their medications on time. It was also alleged that staff place resident’s medications in their bedrooms and leave the room before the medications were consumed by the resident.

The Department’s investigation consisted of an unannounced facility visit, records review, and staff and resident interviews.

[CONTINUED ON LIC9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

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 56-AS-20260320143116

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: 03/27/2026

NARRATIVE

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Review of R1’s medical assessment dated August 13, 2024, revealed that R1 was unable to administer their own prescription medications, unable to administer their own PRN medications, and unable to store their own medications. Review of R1’s Medication Administration Record (MAR) for March 19, 2026, revealed that R1 refused two morning medications. Furthermore, review of the MAR did not reveal that R1 received their medications late following the incident. Interviews with staff and residents provided conflicting statements as to the reasoning of R1 not taking two of their medications. Interviews with staff did not reveal that staff leave medications in residents’ bedrooms nor do staff give medications late.

Based on interviews and record review, the investigation did not yield a preponderance of evidence to conclude staff mismanaged resident's medication. Based on the foregoing, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted with Executive Director Karen Roper and Assistant Executive Director Theresa Gamez, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Hannah Rodgers
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2026

LIC9099 (FAS) - (06/04)

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