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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403554
Report Date: 02/06/2026
Date Signed: 02/06/2026 12:28:21 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE 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
08/25/2021 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210825090919
FACILITY NAME:MAJINTIN VILLEFACILITY NUMBER:
336403554
ADMINISTRATOR:VERLY S. FRIASFACILITY TYPE:
740
ADDRESS:69275 EL CANTO ROADTELEPHONE:
(760) 202-2763
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 2DATE:
02/06/2026
UNANNOUNCEDTIME BEGAN:
11:55 AM
MET WITH:Verly Frias, LicenseeTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Resident developed multiple pressure injuries while in care
Facility staff is not following residents prescribed diet
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver findings of the above allegations. LPA met with Verly Frias, the Licensee. The Department's investigation involved interviews with staff and residents and review of records.

On 08-25-2021, Community Care Licensing (The Department) received a complaint report with the following allegations.

It was alleged that resident developed multiple pressure injuries while in care. Information received indicated that the facility staff have not provided repositioning every two (2) hours to Resident #1 (R1). LPA’s records review revealed that R1 was admitted to the facility in September 2020 under a hospice care plan.

Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026
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 18-AS-20210825090919
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MAJINTIN VILLE
FACILITY NUMBER: 336403554
VISIT DATE: 02/06/2026
NARRATIVE
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R1 was hospitalized and passed away in August 2021. LPA conducted review of wound care progress reports dated 03-08-2021 and 08-02-2021 which revealed that R1 had three (3) pressure injuries. However, the wound care progress reports did not reveal any reason how R1 developed multiple pressure injuries. LPA conducted interviews with the Licensee and Staff #1 (S1), all of whom stated that R1 had received two (2) hour repositioning during R1’s residence at the facility. LPA attempted to obtain R1’s resident file during the facility visits. R1’s resident file was unavailable. LPA’s interview with the Licensee revealed that R1’s resident file was no long available due to expiration of resident records retention period. LPA's records review and interviews conducted did not reveal if the facility staff's neglect played any part in R1 developing multiple pressure injuries. The Department’s investigation did not provide enough information to corroborate the allegation that resident developed multiple pressure injuries while in care. This allegation is unsubstantiated.

It was alleged that facility staff is not following residents prescribed diet. Information received indicated that staff provided wrong kind of nutrition formula to Resident #1 (R1). LPA’s records review revealed that R1 had a gastrostomy tube, and R1’s hospice agency was responsible for ordering and delivering the nutrition formula to the facility. LPA conducted interviews with the Licensee and Staff #1 (S1), all of whom stated that only the correct nutrition formula was provided to R1 following the instruction from R1’s hospice agency. Both the Licensee and S1 stated that R1 had received only the correct nutrition formula delivered by R1’s hospice agency. The Department’s investigation did not provide enough information to corroborate the allegation that facility staff is not following residents prescribed diet. This allegation is unsubstantiated.

A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.



An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2