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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881019
Report Date: 03/19/2026
Date Signed: 03/19/2026 12:32:09 PM

Substantiated


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
03/03/2026 and conducted by Evaluator Andrew Martinez
COMPLAINT CONTROL NUMBER: 56-AS-20260303154622
FACILITY NAME:WILDWOOD CANYON VILLAFACILITY NUMBER:
361881019
ADMINISTRATOR:BARRERA, WENDYFACILITY TYPE:
740
ADDRESS:33951 COLORADO STTELEPHONE:
(909) 446-0405
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:130CENSUS: 63DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Wendy BarreraTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff are not allowing resident to use motorized wheelchair.
INVESTIGATION FINDINGS:
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On March 19, 2026, Licensing Program Analysts (LPAs) Andrew Martinez and Edith Conchas conducted a subsequent unannounced visit to the facility to continue the investigation of the above-mentioned complaint allegation and deliver findings. LPAs were greeted by Business Service Director, Pricilla Vazquez, indicating the reason for the visit and met with Administrator Wendy Barrera. Today’s investigation consisted of additional interviewing and further records review.

The allegation is that staff are not allowing resident to use motorized wheelchair. Interviews with Staff 1 (S1) and Staff 2 (S2) indicate that resident’s (R1) operation of their own motorized wheelchair in the facility began posing a safety concern to self, residents and staff. Based on record review, LPA did not observe staff notes or unusual incident reports of occurrence or of safety concerns reported. Interview with Witness (W1) indicated they were made aware of the facilities concerns and agreed that the equipment should be removed from R1’s usage due to safety concern of the residents in care. However, based on record review, LPA did not observe any documentation stating R1 is not mentally competant to make their own medical decisions.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Andrew Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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 56-AS-20260303154622
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: WILDWOOD CANYON VILLA
FACILITY NUMBER: 361881019
VISIT DATE: 03/19/2026
NARRATIVE
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Documented in R1’s most recent in-house wellness appraisal, dated 01/08/2026, it is indicated that a wheelchair is used as an ambulation aid and states “[resident] will use the wheelchair when the scooter needs charging.” Continuing in the wellness appraisal, under sections titled Cognitive Function, Safety Needs, and Psychosocial, there are no selections indicating that R1 displays cognitive impairment or behavioral issues that pose a safety risk to themselves or other residents in care. R1’s last Medical Assessment for RCFE LIC 602A, dated 07/21/2025, indicates R1 does not have any cognitive conditions or any other medical conditions, but requires assistive devices (“wheelchair/walker”) for motor impairment, and can manage own treatment/medication/equipment.

Based on LPA's interviews and record review on the allegation, staff are not allowing resident to use motorized wheelchair, the allegation is SUBSTANTIATED. A find that is that the complaint is substantiated means that the preponderance of evidence standard has been met. A deficiency per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099D for this allegation.

An exit interview was conducted to discuss the findings of this Complaint Investigation Report. A copy of this report LIC 9099, LIC 9099C, LIC 9099D, and Appeal Rights were provided and discussed with Administrator Barrera whose signature on this form confirms receipt of stated documents.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Andrew Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20260303154622
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: WILDWOOD CANYON VILLA
FACILITY NUMBER: 361881019
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/20/2026
Section Cited
CCR
87468.2(a)(27)
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87468.2(a) In addition to the rights listed in Section 87468.1… residents... shall have all of the following personal rights: (27) To keep, have access to, and use their own personal possessions… unless limited by statute or regulation. This requirement was not being met as evidenced by:
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Administrator will locate R1s motorized wheelchair and return it to R1 with confirmation of complaince via email to LPA by POC due date.
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Based on interviews and record review, facility staff are not allowing resident to use motorized wheelchair which poses an immediate risk to the health safety and personal rights of resident 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: Karen Clemons
LICENSING EVALUATOR NAME: Andrew Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3