336407734-10-9-2025-18-AS-CTUA-DNJNA9-20251118091707

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 10/09/2025
Date Signed: 10/09/2025 01:39:10 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
03/24/2025 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20250324120159

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:	10/09/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Administrator, Genesis Yamberly Garcia		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff exploiting resident’s finances.

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 allegation. LPA met with… who was informed of the purpose of the visit. During the visit, LPA conducted interviews, observations and conducted records review.

It was alleged staff had forced Resident #1 (R1) to designate the facility as their payee for social security, staff had possession of R1’s bank card and PIN code to the bank card. Initial interview with R1 on 04/02/2025 revealed their payee was changed to the facility, Pico de Loro, without their authorization and they were unsatisfied with their new payee. R1 stated they wanted to change their payee from the facility to themselves. R1 was shown the form “Advance Notice of Representative Payment” and R1 did not recall signing the form.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

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-20250324120159

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: 10/09/2025

NARRATIVE

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However, an additional interview conducted with R1 on 07/24/2025, revealed R1 reported they had been upset with the licensee prior and had made false allegations about the facility and the finances. R1 claimed the false allegation was R1 not authorizing the facility as the payee, when in fact she did give authorization for the change. R1 also revealed during the 07/24/2025 interview, that R1 no longer wished to change the payee. R1 wanted Pico De Loro to continue to be the payee and R1 had no issues with the facility.

The administrator provided form “Advanced Notice of Representative Payment” which revealed the facility was chosen to be R1’s payee by the Social Security Administration and was signed on 09/24/2024 by R1 and the administrator as a witness. Interviews with the Licensee and the administrator revealed R1 consented to the facility being their payee.

A review of R1’s Physician Report dated 11/10/2024 revealed R1 could handle their own finances, and report was marked “no” under confused or disoriented. R1’s admission agreement dated 11/30/2023 revealed R1 was their own responsible party.

Interview with R1 on 04/02/2025 revealed the facility had taken R1’s bank card. R1 also recanted this allegation on 07/24/2025 and claimed the allegation was because R1 upset with the facility. R1 further revealed in the 07/24/2025 interview, that the administrator assisted R1 by taking them to the bank but denied that the administrator took possession of the bank card. R1 stated the administrator assisted them in regaining access to their bank account when they had been locked out. Interview with the licensee and the administrator revealed, administrator corroborated that they had assisted R1 to the bank and assisted R1 in obtaining a new bank card and bank account details. Both staff revealed that R1 consented to safeguarding their personal belongings at the facility and showed the LPA a signed form “Authorization to Handle Debit Card” signed 12/01/2023 for R1.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20250324120159

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: 10/09/2025

NARRATIVE

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On 07/24/2025 LPA observed the locked safe where the facility safeguards resident personal information, including R1’s debit card. LPA also observed R1 had their bank card in their possession at the time of the visit, with the administrator reporting R1 had requested their card earlier that day. Both the administrator and R1 revealed the facility safeguards the card and gives the card to R1 when they request it.

It was alleged facility took the bank card and PIN from Resident 2 (R2) as well. R2 was interviewed and denied the licensee took their bank cards and PIN numbers. R2 stated only they have access to their bank cards. LPA interviewed the administrator and the licensee. Both staff denied they asked R2 for their bank card or PIN. Interview with R2’s roommate revealed they were not aware of the licensee requesting R2’s bank card or PIN number. Interview with R2’s responsible party revealed only they handle R2’s finances and were not aware of the licensee requesting R1’s bank card or PIN number. A review of R2’s file revealed no agreement to handle or safeguard R2’s bank card by the facility. During the LPA’s observation of the locked safe, R2’s bank card was not in the safe.

Therefore, based on interviews, record reviews, and observation the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Carolyn Tuba
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 10/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2025

LIC9099 (FAS) - (06/04)

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