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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 10/03/2025
Date Signed: 10/03/2025 03:06:14 PM

Substantiated


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
05/13/2025 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250513170142
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:45CENSUS: 37DATE:
10/03/2025
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Licensee, Efren RiloTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident being overcharged for services
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Efren Rilo, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations/conducted a walk through, and conducted records review.

It was alleged “Resident being overcharged for services”. It was alleged that Resident #1 (R1) was being overcharged for services by the facility applying R1’s personal and Incidental funds (P and I) to pay for R1’s owed rental amount. The Department conducted an audit, interviews, and records review.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
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-20250513170142
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: 10/03/2025
NARRATIVE
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Interview with R1 revealed that for a period of time their social security income was frozen and their rent went unpaid. The facility became their representative payee and since October of 2024 R1 had not received any of their P and I funds. Interview with (2) facility staff including the licensee, revealed that R1 owed the facility rent and when they became the payee for R1 they applied R1’s P and I to the owed rental amount.

Record review of form “Advanced Notice of Representative Payment” revealed the facility was appointed as R1’s payee by the Social Security Administration and was signed by R1 since October 2024. The audit revealed that from October 2024 to July of 2025 the facility had applied R1’s P and I to R1’s owed rent in the amount of $2,076.00.

As of 07/25/2025, interviews with (2) staff including the licensee, LIC405 Record of Resident's Safeguard Cash Resources revealed that the owed rent for R1 was recovered and R1’s account was current. R1 confirmed they were paid $500.00 on 07/25/2025. It was determined the facility owes R1 this total amount.

Based on record review and interview the allegation that the facility overcharged the resident is substantiated, the preponderance of the evidence standard has been met. It was determined that the facility owes R1 $1,576.00. Per California Code of Regulations Title 22, a deficiency was cited and a plan of correction was created. An exit interview was conducted where this report and appeal rights were reviewed and provided.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250513170142
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/03/2025
Section Cited
CCR
87468.2(a)(27)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition…residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (27) To keep, have access to, and use their own personal possessions, including … to…be allowed to spend their own money, unless limited by statute or regulation. This requirement was not met as evidenced by:
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The licensee agreed to pay R1 the money owed and send proof by the POC due date. The licensee stated new procedure for accounting for resident personal incidental funds and board and care.
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Based on interview and record review the licensee used R1’s personal and incidental funds to pay to pay rent owed by R1 against R1’s wishes. This poses an immediate health safety or personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3