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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425024
Report Date: 10/06/2025
Date Signed: 10/06/2025 02:15:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/26/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250826145931
FACILITY NAME:CHINO HILLS SENIOR LIVINGFACILITY NUMBER:
366425024
ADMINISTRATOR:JULIE (OLMEDO) DIONFACILITY TYPE:
740
ADDRESS:6500 BUTTERFIELD RANCH RDTELEPHONE:
(909) 606-2553
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:94CENSUS: 70DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Julie DionTIME COMPLETED:
02:14 PM
ALLEGATION(S):
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Staff are not meeting residents personal hygiene needs.
Staff do not ensure residents are provided with fresh clean linens.
Staff are not providing enough supervision to prevent self harming behavior.
Staff are not dispensing medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Julie Dion and explained the purpose of the visit. The investigation consisted of interviews, record review, and observation.

First allegation: Staff are not meeting residents’ personal hygiene needs. Regarding the allegation LPA conducted interviews with Staff #1 and Staff #2 LPA went over the allegation with S#1 and S#2, Staff #1 and S#2 informed LPA that facility had a meeting with R#1 responsible party regarding concerns addressing to the allegation. Staff #1 and Staff #2 informed LPA that facility cannot force R#1 to take showers, concern that was addressed to R#1 responsible party. Staff #1 and Staff #2 informed LPA that staff encourages R#1 to shower, and brush teeth, and at times encouragement is successful however, other times R#1 refuses. On 8/28/2025, LPA attempted to conduct an interview with R#1 however, R#1 refused and asked to be left alone.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
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 3
Control Number 56-AS-20250826145931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CHINO HILLS SENIOR LIVING
FACILITY NUMBER: 366425024
VISIT DATE: 10/06/2025
NARRATIVE
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On 10/6/2025, LPA conducted a second attempt to interview R#1 LPA went over the allegation with R#1 and R#1 informed LPA that the last time resident showered was a few hours ago. R#1 informed LPA that R#1 likes to shower independently and does not want to be helped or forced. LPA conducted a bathroom inspection LPA observed two bath towels hanging on towel bars LPA also observed that both towels appeared to be damp and used in addition, LPA observed a toothbrush and toothpaste in R#1 bathroom.

Second allegation: Staff do not ensure residents are provided with fresh clean linens. Regarding the allegation LPA conducted a room inspection in R#1 room during the inspection LPA observed R#1 room to be clean, and free of odors. In addition, during the inspection LPA observed that R#1 linens along with pillowcases were clean and free of odors. LPA conducted an interview with S#2 who informed LPA that R#1 receives laundry services once a week and as needed as part of R#1 care plan.

Third allegation: Staff are not providing enough supervision to prevent self-harming behavior. Regarding the allegation LPA conducted an interview with S#2 who informed LPA that when a Pre-appraisal was conducted for R#1 that R#1 already had a behavior of pulling of the hair. In addition, S#2 informed LPA that R#1 responsible party informed facility about R#1 behavior. S#2 informed LPA that staff cannot prevent or stop R#1 from the pulling of the hair behavior as R#1 displays the behavior when R#1 is alone in their room. S#2 informed LPA that anxiety medication was prescribed however, family does not want to move forward with anti-depressant medication for R#1.

Fourth allegation: Staff are not dispensing medication as prescribed. Regarding the allegation LPA conducted a walkthrough of R#1 room during the walkthrough LPA observed R#1 sleeping in addition, LPA observed a set of clothes that was placed next to R#1 bed in addition, LPA observed a pair of compression socks sitting on top of R#1 clothes. S#1 informed LPA that a set of clean clothes along with resident compression socks are always placed next to resident bedside. LPA went into resident’s bathroom and LPA did not observe a medicated shampoo to be in R#1 shower. S#1 informed LPA that because R#1 shampoo is medicated that the shampoo needs to be stored in med-room and dispensed by med team. LPA observed a refusal log and S#1 informed LPA that R#1 medicated shampoo was issued for five-weeks, and R#1 refused to utilize shampoo. S#1 informed LPA that a new order needs to be issued for resident. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20250826145931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CHINO HILLS SENIOR LIVING
FACILITY NUMBER: 366425024
VISIT DATE: 10/06/2025
NARRATIVE
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Unsubstantiated: meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Julie Dion at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3