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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425024
Report Date: 02/25/2026
Date Signed: 02/25/2026 11:19:38 AM

Substantiated


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
11/19/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251119112210
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: 89DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Lizeth (Lisa) GomezTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff do not provide residents with food of good quality
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Business Office Manager Lizeth (Lisa) Gomez and explained the purpose of the visit regarding the allegations listed above.

First allegation: Staff do not provide residents with food of good quality. Regarding the allegation stated above, LPA conducted an interview with Staff #3 LPA went over the allegation with S#3 regarding “Staff not providing residents with food of good quality” Staff #3 informed LPA that staff is aware of the concerns as many residents along with staff have addressed the concerns regarding the food. LPA conducted interviews with Resident #2, Resident #3, and Resident #4, LPA discussed the allegation with the residents and R#2-4 informed LPA that the food quality is very poor and that the temperature of the food when being served is cold. LPA obtained photos of the food that was being served and observed that the food was overcooked, appeared to be burnt and had excess of oil. Based on the evidence gathered during the investigation, the above allegations are Substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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 5
Control Number 56-AS-20251119112210
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: 02/25/2026
NARRATIVE
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 A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 regulations General Food Service Requirements 87555 (a)(b)(8), from division 6, chapter, article 6, is, cited on the attached LIC 9099 D.

An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to the Facility Office Manager Lizeth (Lisa) Gomez, at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
11/19/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251119112210

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: 89DATE:
02/25/2026
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Lizeth (Lisa) GomezTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff do not assist residents with adequate supervision, resulting in resident unclothed in facility
Staff handled resident in a rough manner
Staff do not answer resident's call button in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Business Office Manager Lizeth (Lisa) Gomez and explained the purpose of the visit regarding the allegations listed above.

First allegation: Staff do not assist residents with adequate supervision, resulting in resident unclothed in facility. Regarding the allegation stated above, LPA conducted an interview with Staff #3 LPA went over the alleged allegation with Staff #3 and staff informed LPA that on three separate occasions three residents have exited their rooms unclothed however, S#3 informed LPA that staff have redirected the residents back into their rooms to be clothed. In addition, S#3 also informed LPA that incidents are not due to inadequate supervision but rather due to behavioral circumstances from the residents. Staff #3 further informed LPA that such behaviors have been addressed and have also been reported.

Second allegation: Staff handled resident in a rough manner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
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 5
Control Number 56-AS-20251119112210
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: 02/25/2026
NARRATIVE
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Regarding the allegation stated above, LPA conducted an interview with Resident #5 LPA went over the alleged allegation with Resident #5 and resident informed LPA that Staff #4 has not handled resident in a rough manner. Resident #5 further expressed gratitude towards Staff #4 and denied the incident of being shoved into the elevator by Staff #4. LPA conducted an interview with Staff #4 LPA went over the alleged allegation with S#4 and staff denied handling Resident #5 in a rough manner. Furthermore, Staff #4 informed LPA about assisting Resident #5 into the elevator however, Staff #4 denied shoving Resident #5 into the elevator.

Third allegation: Staff do not answer resident's call button in a timely manner. Regarding the allegation stated above, LPA conducted interviews with Resident #2, Resident #3, Resident #4, and Resident #5, LPA went over the alleged allegation with Residents #2-5 and all informed LPA that while during certain circumstances where staff are assisting other residents the wait time for assistance can take roughly about 30 minutes- 40 minutes. However, Resident #2-5 informed LPA that during emergencies staff will assist right away. LPA conducted an interview with Resident #4 pertaining to an incident involving a possible convulsion that Resident #4 sustained. Resident # 4 informed LPA that resident does not have recollection of the incident however, Resident #4 informed LPA that resident was transported to a local hospital and received treatment. LPA conducted an interview with S#3 who informed LPA that the wait time to respond to signal systems can take about 30 minutes however, Staff #3 informed LPA that the wait time can take longer for non-emergency calls. LPA discussed the incident with Staff #3 involving Resident #4 and Staff #3, confirmed the incident and informed LPA that staff assisted Resident #4 with medical treatment. Based on corroborating evidence the department has determined that the above allegations are 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 Business Office Manager Lizeth (Lisa) Gomez at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20251119112210
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2026
Section Cited
CCR
87555(a)(b)(8)
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General Food Service Requirements 87555....(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents and shall meet the Recommended Dietary Allowances of the Food and Nutrition Board of the National Research Council. All food shall be selected, stored, prepared and served in a safe and healthful manner....(b) The following food service requirements shall apply:....(8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained.

This requirement is not met as evidence by:
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The Licensee has agreed to read over the General Food Service Requirement regulation and will address all concerns with their food service director. Licensee will provide training for all kitchen staff addressing all food service concerns. Licensee will provide LPA with proof of training and will also provide LPA with a plan of action to correct the concerns regarding the Food Service. Plan and training will be emailed to LPA by POC date of 03/20/2026.
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Based on interviews, and record review the Licensee did not comply by adhering by General Food Service Requirements and providing food of poor quality to all residents in care, which can pose a potential Health, Safety, or Personal Rights risk to residents 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: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5