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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 11/13/2023
Date Signed: 11/13/2023 02:40:47 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
10/20/2023 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20231020110520
FACILITY NAME:PICO DE LOROFACILITY NUMBER:
336407734
ADMINISTRATOR:VIVIEN RILLO/EFREN RILLOFACILITY TYPE:
740
ADDRESS:620 NORTH PERRIS BLVDTELEPHONE:
(951) 943-8081
CITY:PERRISSTATE: CAZIP CODE:
92571
CAPACITY:39CENSUS: 37DATE:
11/13/2023
UNANNOUNCEDTIME BEGAN:
12:29 PM
MET WITH:Administrator - Efren Rillo TIME COMPLETED:
02:52 PM
ALLEGATION(S):
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Staff are barricading the residents while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to the facility to investigate and deliver findings to the above allegation. LPA was granted entry and met with Administrator Efren Rillo.

Regarding the allegation "Staff are barricading the residents while in care" LPA conducted staff and resident interviews that do not corroborate the allegation listed above. Resident interviews revealed they do not feel that they are barricaded while in care at the facility and can leave to go out to the community if needed. Interviews with Staff interviews reveal residents are able to go out into the community if they are physically and mentally capable. LPA conducted a tour of the facility and observed and inspected the exit doors leading outside the facility. The facility doors were unlocked and residents had access to the courtyard and shaded seating area outside. LPA noticed a gate along the outside perimeter that was locked. LPA observed the front door of the facility to be locked as well. (CONTINUED LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
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-20231020110520
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: PICO DE LORO
FACILITY NUMBER: 336407734
VISIT DATE: 11/13/2023
NARRATIVE
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During file review LPA found the facility was approved for a locked perimeter due to admissions of residents with dementia served. LPA's record review, observation, and interviews provided no information that could corroborate or refute validity of the allegation. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was reviewed with and provided to Administrator Efren Rillo.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2