336407734-8-10-2025-18-AS-EMAZ-DKQTC5-20250820143611

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 08/10/2025
Date Signed: 08/10/2025 01:46:56 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
05/07/2024 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20240507145414

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:	08:03 AM
MET WITH:	Genesis Garcia		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff member hit resident in care.
Staff member threatened resident in care.
Staff member handled resident in care in a rough manner.
Staff member yelled at resident in care.
Staff member did not treat resident in care with dignity.
Staff member did not ensure that resident in care had access to clean linens.

INVESTIGATION FINDINGS:

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On August 10, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) staff conducted a subsequent complaint visit to continue investigation and to deliver findings. The Department met with Administrator Genesis Garcia who assisted with this visit.

Investigation consisted of:
On May 13.2024, the Department conducted an initial complaint visit and determined that this investigation required further inquiry and possible additional visits and/or phone calls may be necessary to determine findings.
On 7/23/25, the Department obtained (via email) and reviewed the following documents:
Staff roster (dated 7/1/25), Resident Roster (dated 7/7/25), R1’s Pre-placement appraisal (dated 1/18/24) R1’s Physician’s report for RCFE (dated 2/24/25, Medical Progress notes (dated 5/8/24) Internal investigation notes-- written statements (dated 5/7/24, 5/1/24) Incident Report/SOC341 (dated 5/7/25), Appraisal/Needs and Services Plan (dated 2/11/2024) and staff training on residents rights (dated 6/8/25)
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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)

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Control Number 18-AS-20240507145414

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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On 7/14/25, 8/4/25-8/6/25, the department conducted telephone interviews with staff (S2-S8) and Administrator (A1). S1 no longer works at the facility.

On 8/9/25, the department conducted interviews with 7 Residents (R1-R7)

The investigation revealed the following:

Allegation: Staff member hit resident in care.

The details of the complaint allege that S1 "punched" R1 twice for no reason (once in the chest and the other behind her head).

On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that an internal investigation was conducted including a body check and it was found that the allegation is false.

On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding allegation, and of those interviewed, 6 out of 6 denied allegation stating that a no time have they ever “punched” or hit a resident in care. 6 out of 6 stated that they have never witnessed any other staff “punching or hitting a resident at any time. Lastly, 6 out of 6 staff interviewed stated that they have received Residents' Rights Training.

On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that staff has never “punched” or “hit” them at any time. 6 out of 7 stated that staff treats them “good” and they feel safe in the facility. Lastly, 1 of 7 stated that staff are nice sometimes. R1 further stated that generally R1 feels safe in the facility.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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)

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Control Number 18-AS-20240507145414

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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On 8/9/25, the Department obtained and reviewed a copy of the in-service training on Residents’ Rights (dated 6/8/25).

On 7/23/25, the Department received (via email) and reviewed a copy of progress notes from doctor (dated 5/8/24, the day after the allegation was made). The progress note did not indicate that there was bruising or indication of distress resulting from a “physical assault.”

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

Allegation: Staff member threatened resident in care.

The details of the complaint allege that S1 told R1 “You better not tell anyone about this, no one will believe you, and if you do, I will kill you.”

On 7/14/25 at 4:15pm the Department interviewed the Administrator (via telephone) who denied allegation, stating that there was an internal investigation that found the allegation to be false.

On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and of those interviewed, 6 out of 6 denied the allegation stating they have never witnessed any staff making threats to R1.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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)

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Control Number 18-AS-20240507145414

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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On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 7 out of 7 stated that staff never made threats to them nor have they witnessed any staff making threats to other residents.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

Allegation: Staff member handled resident in care in a rough manner.

The details of the complaint allege that on Saturday (5/4/24) R1 was “roughed up” by S1.

On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation that S1 “roughed up” R1 is false.

On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and of those interviewed, 6 out of 6 denied the allegation stating they have never handled a resident in a rough manner, nor have they witnessed any other staff handling a resident in a rough manner.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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-20240507145414

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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On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed 6 out of 7 stated that they have never been handled in and rough manner nor have they witnessed any staff handling a resident in a rough manner.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

Allegation: Staff member yelled at resident in care.

The details of the complaint allege that staff yelled at resident in care.

On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation of S1 yelled at R1 is false. On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and 6 out of 6 denied the allegation stating they have never yelled at a resident, nor have they witnessed any other staff yelling at a resident. On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that they have never been yelled at nor have they witnessed any other staff yelling at a resident.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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-20240507145414

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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Allegation: Staff member did not treat resident in care with dignity.

The details of the complaint allege that S1 shoved R1 into her wheelchair to take a shower

On 7/14/25 at 4:15pm the Department interviewed the Administrator (via telephone) who denied allegation, stating that based on their internal investigation, the allegation of S1 shoving R1 into a wheelchair to take a shower is false.

On 8/6/25 and 8/9/25, the Department interviewed a total of 6 staff regarding the allegation, and 6 out of 6 denied the allegation stating they have never witnessed R1 being shoved in her wheelchair to take a shower at any time.

On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed, 6 out of 7 stated that they have never witnessed staff shoving R1 in a wheelchair to take a shower.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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-20240507145414

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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Allegation: Staff member did not ensure that resident in care had access to clean linens.

The details of the complaint allege that S1 gave R1 dirty towels to dry herself after the shower.

On 7/14/25 at 4:15pm the department interviewed the Administrator (via telephone) who denied allegation, stating that the facility always provides clean linens to the residents.

On 8/9/25 between 10:00am and 1:00pm, the Department interviewed 7 residents (R1-R7) and of those interviewed 7 out of 7 stated that they are provided with clean towels when they take showers and/or bath.

On 8/10/25 during the tour of the facility the Department witnessed that there was an ample supply of clean linens available for residents’ use.

Based on the information gathered, there is insufficient evidence to support the stated allegation.

Although the allegation above 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
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)

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