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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423972
Report Date: 07/24/2025
Date Signed: 07/24/2025 07:08:22 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
07/07/2025 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250707095241
FACILITY NAME:WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCIIFACILITY NUMBER:
336423972
ADMINISTRATOR:JACQUELYN J. WHITEFACILITY TYPE:
740
ADDRESS:24068 RISTRAS LANETELEPHONE:
(951) 691-8309
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 2DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
03:27 PM
MET WITH:Staff, Aidan HaganTIME COMPLETED:
07:15 PM
ALLEGATION(S):
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Absence of staff supervision
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 Staff, Aidan Hagan who was informed of the purpose of the visit. LPA conducted interviews, conducted a walk through, and conducted records review.

It was alleged an “Absence of staff supervision” occurred at the facility where no staff were present on 06/30/2025 to supervise residents.Staff #1 (S1) and Staff #2 (S2) were interviewed and revealed they were both at the facility on 06/30/2025. S1 and S2 alleged S2 was in the restroom when S1 left the facility. Screen captured image from a location app verified S1’s departure time from the facility was 1:36pm.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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-20250707095241
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: WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII
FACILITY NUMBER: 336423972
VISIT DATE: 07/24/2025
NARRATIVE
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S2 then revealed they heard someone knock on the front door when they were in the restroom, which was later answered by Staff #3 (S3). Screen captured image of S3’s location app showed they arrived at the facility at 1:47pm. S2 revealed after coming out of the restroom, S2 left out the front door. S2 did not have any proof of S2’s arrival or departure to the facility.

Interview with Staff #3 (S3) was attempted in person and over the phone, however they were unavailable for interview.

An interview with a confidential witness #1 (W1) was corroborated by police body camera footage and incident report. The footage shows W1 arrived to the facility at 1:36pm, where they did not receive a response until 1:46pm when S3 arrived at the facility. W1 visits Resident #1 (R1)’s room located next to the front door of the facility. A tour of the home is conducted and S3 is then questioned on who was with the facility residents prior to their arrival. S3 states S1 had just left through the front door when W1 was in R1’s room. However, W1 revealed in both footage and interview that they did not hear anyone leave through the front door. S1 was called immediately at 2:02pm, S1 informs they had left the facility 30 minutes prior, contradicting S3’s statement that S1 had just left. S1 then states S2 was at the home when they left, again contradicting S3’s statements that S1 was present last. After contacting S1, S3 changed their statement stating that S2 was present prior to their arrival, not S1.

LPA attempted to interview R1 and R2, however they were not alert or oriented to questions asked by the LPA.

Therefore, based on interviews, records review and observation the allegation that there was an absence of staff supervision on 06/30/2025 is substantiated. The preponderance of evidence standard has been met, therefore California Code of Regulations Title 22 is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided. Attempt to contact the licensee was conducted and the Licensee's spouse provided information on plan of correction.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250707095241
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: WHITE'S LOVE & CARE RESIDENTIAL ELDERLY HOME INCII
FACILITY NUMBER: 336423972
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/25/2025
Section Cited
CCR
87468.2(a)(4)
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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities
(a)…residents…have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers… to meet their individual needs. This requirement was not met as evidenced by:
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The licensee's spouse agreed to have the licensee submit a written statement showing terminiation date for S1 by the POC due date. The licensee's spouse
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Based on interview and record review, there were no staff supervision for at least 10 minutes on 06/30/2025. This poses an immediate health safety, or personal rights risk to residents in care.
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agreed to hire a replacement for S1 and submit an LIC500 showing staff coverage at all times.
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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: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
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