336407734-8-10-2025-18-AS-JHAD-DKPQM4-20250819121657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 08/10/2025
Date Signed: 08/10/2025 04:27:34 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 Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231020110520

FACILITY NAME:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	45	CENSUS: 38	DATE:	08/10/2025
		UNANNOUNCED	TIME BEGAN:	07:59 AM
MET WITH:	Genessis Garcia		TIME COMPLETED:	02:59 PM

ALLEGATION(S):

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Staff forged a confidential document for a resident.
Staff are financially abusing a resident while in care.

INVESTIGATION FINDINGS:

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On August 10, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Administrator Genessis Garcia greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above.

The investigation included interviews, a collection of records, and a tour of the facility on November 11, 2023, August 09, 2025, and August 10, 2025. Interviews were conducted with Resident #1 to Resident #7, Staff #1 through Staff #6 (S1-S6). The Department reviewed several documents, including the Register of Facility Residents LIC 9020 (dated 07/14/25), the Personnel Report LIC 500 (dated 07/01/25) and Resident #1 (R1)'s Physicians Report LIC 624A (dated 09/19/24 & 01/05/23), In Service/Meeting Training(dated 06/08/25), and as well as other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

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 7

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 Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231020110520

FACILITY NAME:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	45	CENSUS: 38	DATE:	08/10/2025
		UNANNOUNCED	TIME BEGAN:	07:59 AM
MET WITH:			TIME COMPLETED:	02:59 PM

ALLEGATION(S):

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9

Staff are barricading the residents while in care.

INVESTIGATION FINDINGS:

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***This report supersedes the report dated 11/12/23. This report, 08/10/25, is created to clarify the findings “Staff are barricading the residents while in care" of unsubstantiated. All other aspects of the complaint report remain in effect.***

On August 10, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent unannounced complaint visit. Administrator Genessis Garcia greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, a collection of records, and a tour of the facility. Interviews were conducted with Resident #1 to Resident #7, Staff #1 through Staff #6 (S1-S6). The Department reviewed several documents, including the Register of Facility Residents LIC 9020 (dated 07/14/25), the Personnel Report LIC 500 (dated 07/01/25), and Resident #1 (R1)'s service records, as well as other pertinent records associated with this complaint.
(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 7

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: 08/10/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #3: Staff are barricading the residents while in care.

The complaint alleges that the staff at the facility barricaded Resident #1 (R1) while in care. It is reported that (R1) is unable to leave the facility, as the doors are secured with chains. No additional details were provided regarding this situation.

On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to corroborate this claim. (R2-R7) asserted that the facility's doors are not secured with chains, which restricts their ability to leave the premises. Furthermore, no residents are prohibited from leaving the facility.

(R1) firmly stated that this claim is invalid. (R1) confirmed (R1's) independence and said that (R1) can leave the facility unattended. (R1) expressed the ability to be independent and continued to drive a vehicle without any restrictions on leaving the premises.

On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S6) stated (R1) is independent and can leave the facility no assistance. According to (S1-S3), (R1) enjoys the liberty of exploring various rooms within the premises freely. The environment is open and accessible, there are no locked chains on the doors that would serve as barriers. (R1) has the freedom to leave the facility with no assistance at any time without any restrictions.

As a result of review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed the (R1) is able to leave the facility unassisted. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly.

During the visit on August 9, 2025, the Department observed that the facility actively promotes the rights of its residents. The facility had posters detailing Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster prominently displayed throughout the premises. An inspection of the premises and (R1’s) room on August 10, 2025 and November 13, 2025 revealed no restricted chains on any doors.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 7

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: 08/10/2025

NARRATIVE

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Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 7

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: 08/10/2025

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff forged a confidential document for a resident.

The complaint alleged that staff at the facility forged a confidential document for Resident #1 (R1), a life-sustaining form. This form, featuring signatures from both (R1) and the primary physician at the facility, was completed in April 2023. However, (R1) was only made aware of the forgery on October 19, 2023. No additional details were provided regarding this matter.

On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to validate this claim. (R2-R7) indicated they were aware of signing confidential records and had no issues or concerns with their confidential documents.

(R1) claimed that this assertion is false. Furthermore, (R1) confirmed that the signature on the Physician’s Order for Life Sustaining Treatment (POLST) form is indeed (R1’s) signature, eliminating any possibility of it being forged.

On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to validate this claim. (S1-S3) indicated that (R1) was admitted to the facility without having a power of attorney, conservator, or public guardian representing (R1). (R1) signed all confidential agreement documents, including the life-sustaining record. (S1-S6) all claimed to have completed Personal Rights in Residential Care Facilities for the Elderly (RCFE).

A review of Resident #1 (R1's) Physician's Orders for Life Sustaining Treatment (POLST) (dated 04/06/23), Identification and Emergency Information LIC 601 (dated 01/04/23), Residential Care for Elderly Admission Agreement (dated 01/04/23), Admission Financial Agreement (dated 01/04/23), and Preplacement Appraisal LIC 603 (dated 07/28/22) revealed all had identical signature to (POLST). Further review of Physician's Orders (dated 06/26/25) listed (R1) is prescribed a total of (14) medications. It revealed that (12) out of the (14) medications have side effects of cognitive effects, depression, anxiety, confusion, or dizziness (ref: National Institute of Health). A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly.

(Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 7

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: 08/10/2025

NARRATIVE

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Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above.

Allegation #2: Staff are financially abusing a resident while in care.

The complaint alleges that the staff are financially abusing Resident #1 (R1). It has been reported that the facility's administrator is withholding (R1’s) money and checks, as well as (R1’s) bank statements. The administrator only provides (R1) with $100 in cash, while the remainder of the funds goes to the facility. No additional details were provided regarding this matter.

On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents were not able to support this claim. (R2-R7) stated that they had no issues or concerns regarding their financial matters, as the facility's administrators do not manage their finances.

(R1) asserted that the claim is incorrect. Additionally, (R1) stated that (R1) independently manages (R1’s) finances and that no one else has access to (R1’s) financial bank accounts.

On August 09, 2025, between 09:00 AM and 03:30 PM, the Department interviewed the staff identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members were not able to support this claim. (S1-S3) indicated that (R1) self-admitted to Pico De Loro on January 4, 2023. They stated that the facility does not manage (R1's) finances; (R1's) rent expenses will be covered through (R1's) personal bank account. Additionally, the facility does not maintain any Personal and Incidental funds for (R1).

A review of Resident #1 (R1's) Physicians Report LIC 624A (dated 09/19/24 & 01/05/23) revealed that (R1) has the capacity for self-care and can manage cash resources. Further review of Rent Receipts (dated 01/01/23 through 07/31/23) validated that (R1) handles (R1’s) finances. A review of In Service/Meeting (dated 06/08/25) revealed all staff members have completed training on Personal Rights of Residents in Residential Care Facilities for the Elderly.

(Evaluation Reports continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

LIC9099 (FAS) - (06/04)

Page: 6 of 7

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: 08/10/2025

NARRATIVE

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Based on the information gathered, there is not enough evidence to corroborate the allegation mentioned above.

Based on the information collected from the facility inspections, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated.

An exit interview was conducted with the Genessis Garcia, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 08/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2025

LIC9099 (FAS) - (06/04)

Page: 7 of 7