336407734-8-10-2025-18-AS-JHAD-DKPQHV-20250819121147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 08/10/2025
Date Signed: 08/10/2025 05:20:36 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
02/16/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230216085532

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:	02:37 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff refused to accept resident back into the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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), and Witness #1 (W1). 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 12/10/22), Residential Care for Elderly Admission Agreement (dated 12/09/22), Identification and Emergency Information LIC 601 (dated 12/09/22), Narrative Charting (dated 02/10/23 through 02/15/23) and telecommunications messages dated 02/14/23), 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 3

Control Number 18-AS-20230216085532

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff refused to accept resident back into the facility.

The complaint states that the staff refused to accept Resident #1 (R1) back into the facility. It is reported that (R)1 was hospitalized and ready for discharge, but the facility administrator declined to allow (R1's) return due to the resident's behavior. Additionally, reports indicate that the facility has a history of "patient dumping," which involves refusing to readmit (R1). No further details were provided regarding this situation.

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-S2) stated that (R1) was hospitalized on February 11, 2023, at Global Medical Center for medical evaluation and was kept under assessment. (S1) said to have been in touch with the hospital during (R1's) hospitalization and denied not accepting (R1) back into the facility when available for discharge on February 15, 2023. (S1) stated to have been in contact with (R1's) primary conservator and mentioned that (R1) will need to be reexamined by the neurologist upon (R1's) return to the facility. (S1) stated that (R1's) conservator disapproved of (R1's) neurologist and had disagreements regarding patient care and prescribed medications, which led to (R1) exhibiting malevolent behaviors. Evidence of narrative charting and telecommunication messages between (R1's) family conservator and (S1) will reveal that the facility has not abandoned (R1) and has not evicted (R1) according to (S1). (S1-S2) reported that (R1) was never served with an eviction notice and denied practicing "patient dumping." Furthermore, (S1-S2) emphasized that (R1's) conservator did not notify them regarding (R1's) decision to no longer return to the facility while still receiving care at the hospital. It became apparent that (R1) had been transferred to another assisted living facility selected by the conservator, and (R1's) residency was abruptly terminated without any warning. (S1-S6) all claimed to have completed Personal Rights in Residential Care Facilities for the Elderly (RCFE).

On August 09, 2025, between 10:00 AM and 01:30 PM, the Department interviewed the residents identified as Resident #2 through Resident #7 (R2-R7). Six (6) out of the seven (7) residents were not able to support this claim. (R2-R7) stated that they had no concerns regarding this matter. They expressed appreciation for the treatment they receive from the staff, who are professional and welcoming. All have stated they have not seen residents denied re-entry into the facility after hospitalization.

(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: 2 of 3

Control Number 18-AS-20230216085532

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The Department was unable to interview Resident #1 (R1) because (R1) was no longer available at the facility and had left with no forwarding contact information.

The Department attempted to contact the family conservator, identified as Witness #1 (W1), multiple times by telephone; however, the calls went unanswered.

As a result of the review of Resident #1 (R1's) Physicians Report LIC 624A (dated 12/10/22) revealed that (R1) suffers from a neurological disorder and requires medications to control aggressive behaviors. A review of (R1's) Medication Administration Record (MAR) (dated 02/01/23 through 02/28/23) revealed (R1) was prescribed (9) medications and (5) out of the (9) are to treat neurological disorder. Further review of (R1’s) Residential Care for Elderly Admission Agreement (dated 12/09/22), Identification and Emergency Information LIC 601 (dated 12/09/22) revealed (R1’s) family member (W1) holds conservatorship and has control to make decisions for (R1). Narrative Charting (dated 02/10/23 through 02/15/23) and telecommunications messages dated 02/14/23) showed that the facility was not engaging in “patient dumping” nor had the facility served an eviction notice to (R1) and that the conservator had decided to terminate residency by choice. 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.

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: 3 of 3