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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 03:04:59 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
12/08/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20231208140426
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:
01:19 PM
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 conducted a subsequent complaint visit regarding the above allegation. LPA Richard met with the Administrator Julie Ramirez, and the purpose of this visit was explained. LPA toured the facility.

The investigation included the following: On 12/14/2023, Licensing Program Analyst (LPA) Kathleen Banrasavong visited the facility to begin the investigation into the allegations listed above. The LPA met with the Administrator (A1), Julie Ramirez. The LPA also interviewed the caseworker (CW) regarding the Assisted Living Waiver Program.
On 02/11/2026, LPA reviewed and requested the following documents: the residents roster and the staff roster. LPA reviewed and requested Residents #1-5, Admissions Agreement, and Physicians' Reports. LPA also requested and obtained the following documents for Resident #1 (R1): Residents' Appraisals, Needs & Services, and copies of 7 Social Security checks, a handwritten note, and the signature of R1. LPA interviewed five residents (R1-R5), four Staff members (S1-S4), and the Administrator (A1).
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-20231208140426
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 Administrator brought Social Security checks to the resident at a skilled nursing facility for signature and did not return to deliver the funds to R1.

On February 11, 2026, at 11:00 AM, LPA Richard interviewed the administrator (A1), who denied the allegation. A1 stated R1 moved into the facility on 12/08/2022 and that R1's Social Security benefits did not start until 05/1/2023. R1 moved out of the facility on 07/31/2023. R1 still owed the facility back payments for the five months preceding the move-in date.

On 12/16/2023, A1 visited R1's residence, had R1 sign the checks for the back rent, and gave R1 the remaining funds after all rent was paid. On February 11, 2026, at 11:55 AM, LPA Richard interviewed four staff members #1-4, (S1-S4). All four denied the allegation, stating 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 interviewed five residents (R2-R6). All five denied any issues with their money. Residents R2, R3, and R4 stated that the payee deposited the funds into their respective bank accounts. On 12/16/2023, LPA interviewed the Case Worker (CW), who denied the allegation and explained that the resident stayed at the facility and was not paying full rent due to SSI being in limbo. CW also stated that R1 owes the facility back pay. CW added that this ALW has ceased because R1 has not been residing at the Country Club Guest Home since June 2023.

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-20231208140426
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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On February 11, 2026, LPA Richard examined R1’s records, which showed seven copies of Social Security checks and a letter explaining the breakdown of the start of benefits. LPA also reviewed a handwritten note and signature of R1 receiving extra money from A1 for 2022 and 2023. Additionally, copies of the returned checks were sent to the Department of the Treasury because R1 no longer lives at the facility. LPA was unable to interview R1 because R1 moved out of the facility on 07/31/2023.

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