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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880570
Report Date: 08/06/2025
Date Signed: 08/06/2025 02:46:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
10/15/2024 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20241015093925
FACILITY NAME:ALTA LOMA GARDENS RESIDENTIAL CARE #1FACILITY NUMBER:
361880570
ADMINISTRATOR:STARK PLEITEZ, ANAFACILITY TYPE:
740
ADDRESS:6896 HELLMAN AVETELEPHONE:
(909) 244-9031
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 6DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ann Margarita Pleitez, AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
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9
Staff do not provide adequate food service
Staff did not properly maintain a resident's bedroom
Staff did not ensure the facility door is properly maintained
INVESTIGATION FINDINGS:
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***This is an Amended report orginated on 4/3/2025***

On 04/03/2025, at 03:00 PM, Licensing Program Analyst (LPA), LaVette Farlow, conducted an unannounced visit to the facility to conclude the investigation and deliver findings to the above-mentioned complaint. LPA met with Staff, AJ Espino who was informed of the reason for today's visit. The investigation consisted of interviews with staff and clients and records review.

The first allegation is Staff do not provide adequate food service. LPA Farlow interviewed R1, R2, R3, and R4, and they all indicated that the facility has an adequate amount of food. R1, stated the food was okay, just would like a different variety. R2, R3, and R4 stated they were satisfied with the meals. LPA Farlow interviewed staff S1, S2, S3, S4, S5, S6, and S7 and they all indicated that the facility does have an adequate amount of food for residents in care, and those resident with special dietary needs. ***Continued in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
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 4
Control Number 56-AS-20241015093925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ALTA LOMA GARDENS RESIDENTIAL CARE #1
FACILITY NUMBER: 361880570
VISIT DATE: 08/06/2025
NARRATIVE
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S1 stated during his employment at the facility he would prepare a grocery list every Thursday. S1, S2, S4, S5, and S7 all stated they prepare meals for residents in care and things may run low, but they had never been completely out of food. Also, the administrator does a weekly grocery run. LPA Farlow did not find evidence to corroborate the allegation.

The second allegation indicated that staff did not properly maintain a resident’s bedroom. LPA Farlow interviewed R1, R2, R3, and R4 and all residents indicated that staff come and complete the cleaning of the room several times a week and as needed. LPA Farlow interviewed S1, S2, S3, S4, S5, S6 and S7 and all staff indicated that the staff and administrator are very strict about the cleanliness of the facility. During the visit, LPA observed that the facility was clean, smelled fresh and the rooms were maintained. LPA Farlow did not find evidence to corroborate the allegation.

The fifth allegation indicates staff did not ensure the facility door is properly maintained. LPA Farlow interviewed staff and the following was revealed. S1, S2, S4, S5, S6, and S7 all stated there was an issue with the door, but it was repaired immediately. S3 stated that when staff notified S3 of the door issues it was repaired the same day. LPA observed front door during LPAs visit and did not observe any problems with the front door. LPA Farlow did not find evidence to corroborate the allegation.

Based on LPA Farlow’s interviews, and observation, the allegations staff do not provide adequate food service (Allegation 1), staff did not properly maintain a resident’s bedroom (Allegation 2), staff did not ensure the facility door is properly maintained (Allegation 5) are UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means although the allegation 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 at this time.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
10/15/2024 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20241015093925

FACILITY NAME:ALTA LOMA GARDENS RESIDENTIAL CARE #1FACILITY NUMBER:
361880570
ADMINISTRATOR:STARK PLEITEZ, ANAFACILITY TYPE:
740
ADDRESS:6896 HELLMAN AVETELEPHONE:
(909) 244-9031
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:6CENSUS: 6DATE:
08/06/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Ann Margarita Pleitez, AdministratorTIME COMPLETED:
02:50 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not have adequate record keeping for the residents
Staff force a resident to sleep
INVESTIGATION FINDINGS:
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The third allegation indicates staff do not have adequate records keeping for the residents. LPA Farlow interviewed S1, S2, S4, S5, S6, and S7 and they stated staff have access to the emergency file if the resident is escorted to the hospital. S3 indicated that staff do not need to have access to resident files for security reasons. Overall, the preponderance of evidence supports that facility staff do not have adequate record keeping for review for residents in care. Based on LPA Farlow’s interviews and record review, the preponderance of evidence standard has been met, and the allegation staff do not have adequate records keeping for the residents is SUBSTANTIATED.

The fourth allegation indicates staff forces a resident to sleep. LPA Farlow interviewed staff and resident in care. Interviews with R1 revealed staff are making R1 go to room early and R1 would like to stay up and in the common area longer. Interviews with R2, R3, and R4 stated they do not have any issues with staff forcing them to bed early. LPA Farlow interviewed staff and the following was revealed. S3 stated she was not aware of staff forcing residents to sleep and that is not allowed. Interviews with S4, S6, and S7 revealed that staff would assist R1 to bed or to her room. Also, staff stated R1 is a heavier size resident and requires two staff to get her in bed. S6 stated that S6, and S1 would assist the S4 with putting R1 in her room. S6 stated R1 was not comfortable with using the Hoyer lift, so two staff are needed to move R1. Based on the evidence, and interviews, there is a lack of staff available to assist residents to move around the facility after 6:00 PM, which does not meet residents’ needs and allows residents to be in the common area after 6:00 PM. Based on the interviews, the allegation staff forcing a resident to sleep is found to be SUBSTANTIATED.
Based on LPA Farlow’s interviews and record review, the preponderance of evidence standard has been met, and therefore the above allegations of staff do not have adequate record keeping for the residents and staff forcing a resident to sleep is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulation, (Title 22, Division 6 & Chapter 6) is being cited on the attached LIC9099D.
An exit interview was conducted where this report, LIC9099, LIC9099C, and LIC9099D was discussed and provided to Administrator, Ann Margarita Pleitez.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20241015093925
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALTA LOMA GARDENS RESIDENTIAL CARE #1
FACILITY NUMBER: 361880570
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/22/2025
Section Cited
CCR
87506(a)
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87506(a)licensee shall ensure that a separate, complete, and current record is maintained for each resident...location..available to facility staff and to licensing agency staff.
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Licensee agrees to write a statement of understanding for section cited 87506(a) and when send by POC date.
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Based on interviews, and records review, the licensee did not comply with the section cited above due to facility staff not having access to residents complete files.
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Type B
08/22/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)Residents in all residential care facilities.. all of the following personal rights(3)To be free from punishment, humiliation, intimidation, abuse..punitive nature, such as withholding.. interfering with daily living functions..sleeping, or elimination.
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Licensee agrees to make sure staff does not interfere with resident desire to stay up after 6PM. Licensee agrees to ensure there is sufficient staffing to meet the residents needs. Licensee will send a statement of understanding by POC date.
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Based on interviews, the licensee did not comply with the section cited above by not ensuring sufficient amount of staff are available to assist with residents needs. Also, staff was encouraging residents to go to there rooms at 5:30 PM.
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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: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4