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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 372004630
Report Date: 02/11/2026
Date Signed: 02/11/2026 03:09:29 PM

Unsubstantiated


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
07/10/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20230710110439
FACILITY NAME:COUNTRY CLUB GUEST HOMEFACILITY NUMBER:
372004630
ADMINISTRATOR:RAMIREZ, JULIEFACILITY TYPE:
740
ADDRESS:25533 RUA MICHELLETELEPHONE:
(760) 747-0957
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:30CENSUS: 27DATE:
02/11/2026
UNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Julie RamirezTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident is being financially abused by licensee.
INVESTIGATION FINDINGS:
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On 02/11/2026, Licensing Program Analyst (LPA) Antonine Richard investigated the above allegation. LPA Richard met with the Administrator Julie Ramirez, and the purpose of this visit was explained.

The investigation consisted of the following:
During today’s visits, LPA toured the entire facility. On 02/11/2026, LPA reviewed and requested the following documents: residents roster and staff roster. LPA reviewed five Residents #1-5 (R1-R5) Admissions Agreement, Physicians' Reports, and Medication records. LPA also requested and obtained the following documents for Resident #1 (R1): Residents' Appraisals, Needs & Services, and two checks from DBA Senior Impact. LPA interviewed five residents (R1-R5), four staff members (S1-S4), and the Administrator (A1).

Report continued on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
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 18-AS-20230710110439
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: COUNTRY CLUB GUEST HOME
FACILITY NUMBER: 372004630
VISIT DATE: 02/11/2026
NARRATIVE
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Allegation: Resident is being financially abused by the licensee.

The complaint alleged that the residents (R1) had not received a check from the licensee for a couple of years. On February 11, 2026, at 11:00 AM, LPA Richard interviewed the Administrator (A1), who denied the allegation. A1 stated that DBA Senior Impact sends two $15 checks to the facility address in R1's name. A1 assisted R1 in going to the check-cashing location on Fig Street in Escondido to cash the check. After R1 cashed the check, the facility is not responsible for how R1 uses that money. A1 also mentioned that after the complaint was filed, A1 contacted the payee, who subsequently helped R1 with the supplemental check.

On February 11, 2026, at 11:55 AM, LPA Richard interviewed four staff members #1-4 (S1-S4). All four denied the allegation and stated that they are not involved in managing residents' personal funds and P&I; they only assist residents with shopping, and residents control their own money.

Later, at 12:15 PM the same day, LPA Richard interviewed five residents (R1-R5). All five denied experiencing any issues with their money. Residents R2, R3, and R4 stated that the payee deposited the money into their bank accounts. R1 also mentioned that their social workers are currently assisting them with cashing their checks.

On February 11, 2026, LPA Richard examined R1’s records, which showed two checks from Senior Impact for $15 each, dated February 1, 2022, and August 1, 2023. The facility has stopped receiving the R1 supplement check from Senior Impact.

Report Continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230710110439
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: COUNTRY CLUB GUEST HOME
FACILITY NUMBER: 372004630
VISIT DATE: 02/11/2026
NARRATIVE
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Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation: 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.

No deficiencies were cited.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Julie Ramirez.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3