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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530266
Report Date: 08/06/2025
Date Signed: 08/06/2025 01:08:44 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
07/29/2025 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20250729090914
FACILITY NAME:LAKES, THEFACILITY NUMBER:
335530266
ADMINISTRATOR:MATSUSHITA, LORIFACILITY TYPE:
740
ADDRESS:5801 SUN LAKES BLVDTELEPHONE:
(915) 845-2220
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:276CENSUS: 131DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Cristina Ceballos, Executive DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not ensure the facility was free of pests
Staff did not ensure the facility bus was not in disrepair
INVESTIGATION FINDINGS:
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On 8/06/2025 at 10:10 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to iniate the investigation and deliver the findings of the above allegations. LPA Serrano met with Executive Director Cristina Ceballos to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation.

Allegation #1: Staff did not ensure the facility was free of pests – Based on record review, observation/inspection of the facility, The facility has a contract with a pests company and provided invoice to show the services rendered. The facility provided the Department of Health recent inspection and gave the facility an A rating. Based on interviews, they all stated that they have not observed any rodents or any pests activity in the facility. LPA was unable to corroborate the allegation.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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 56-AS-20250729090914
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: LAKES, THE
FACILITY NUMBER: 335530266
VISIT DATE: 08/06/2025
NARRATIVE
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Allegation #2: Staff did not ensure the facility bus was not in disrepair - Based on interviews, record reviews and LPA observation and information received during the investigation, LPA was unable to corroborate the allegation. The vehicle needs the operator/charter permit from Public Utilities Commission and California Highway Patrol clearance to operate the vehicle. LPA observed the bus is in good repair and the facility provided the filed paperwork needed to operate the bus/van. Based on interviews, they all stated that the bus is in good repair.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Executive Director Cristina Ceballos.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2