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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413084
Report Date: 11/04/2021
Date Signed: 11/04/2021 12:28:05 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/02/2021 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211102102202
FACILITY NAME:GEM'S SENIOR LIVING IFACILITY NUMBER:
336413084
ADMINISTRATOR:GERLITA HIGAFACILITY TYPE:
740
ADDRESS:28701 PORTSMOUTH DRIVETELEPHONE:
(951) 672-1470
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:6CENSUS: 2DATE:
11/04/2021
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Princess Janolino CaregiverTIME COMPLETED:
12:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff member physically abused resident while in care.
Staff member verbally abused resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) arrived unannounced at the facility to commence a complaint investigation. LPA was greeted and granted entry by Caregiver Princess Janolino. LPA met with Administrator Gerlita via telephone. This agency has investigated the complaint alleging "Staff member physically abused resident while in care and Staff member verbally abused resident while in care".

Upon further investigation through conducted interviews, it was revealed that the resident in question does not reside at the facility.

We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted and a copy of this report was provided to Caregiver Princess Janolino.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021
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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