565850439-4-2-2026-29-AS-KHEN-DTKUMJ-20260428154223

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850439
Report Date: 04/02/2026
Date Signed: 04/02/2026 04:58:39 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/11/2026 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20260211112820

FACILITY NAME:	RINCON ASSISTED LIVING		FACILITY NUMBER:	565850439
ADMINISTRATOR:	SPRING, REBECCA		FACILITY TYPE:	740
ADDRESS:	67 EAST BARNETT ST.		TELEPHONE:	(805) 643-2176
CITY:	VENTURA	STATE: CA	ZIP CODE:	93001
CAPACITY:	54	CENSUS: 49	DATE:	04/02/2026
		UNANNOUNCED	TIME BEGAN:	01:20 PM
MET WITH:	Juliana Anos, Facility Designee		TIME COMPLETED:	05:05 PM

ALLEGATION(S):

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Staff did not administer resident's medication as prescribed.
Staff did not safeguard residents personal belongings.
Staff are allowing resident to smoke inside the facility.
Staff are not providing adequate food service to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced subsequent complaint visit related to the above allegations. Upon arrival, the LPA met with Facility Designee Veronica Pereyra and explained the reason for the visit. Entrance interview conducted.

During today's visit, LPA interviewed three (3) staff and one (1) resident between 01:26PM to 03:10PM and LPA obtained copies of pertinent documents. During an initial complaint visit on 02/12/2026, LPA interviewed facility designee at 12:12PM, Program Manager at 12:43PM, toured the facility with Program Manager at 02:03PM, and LPA interviewed six (6) residents from 02:20PM to 03:15PM. LPA reviewed and obtained copies of relevant documents.Throughout the course of the investigation, LPA attempted to contact Resident #1 (R1) multiple times via telephone, but LPA did not receive a call back. LPA also interviewed Facility Administrator during an unrelated visit. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260211112820

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RINCON ASSISTED LIVING	FACILITY NUMBER: 565850439
	VISIT DATE: 04/02/2026

NARRATIVE

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Allegation "Staff did not administer resident's medication as prescribed:"
The complaint alleges that from 12/28/2025 to 01/08/2026, staff withheld medications from R1 without explanation. Interview revealed that R1 had been away from the facility from mid-December until 12/27/2025. When R1 returned to the facility, R1 wanted their medications surrendered to them personally. At the time, R1 was conserved and unable to manage their own medications. Interviews revealed that R1's conservator instructed the facility staff on how to handle R1's medications and not to release the medications to R1. At that time, R1 was also taken to the hospital and medications were changed. Staff again reached out to R1's conservator related to R1's medication and R1's conservator made the decision to withhold medications until R1 visited their psychiatrist. LPA reviewed medication records for R1 for that time period, which reflect the conservator's communication and that the facility followed R1's conservator's direction. Other residents interviewed indicated they always get all their medications and there have never been problems with their medications.The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

Allegation "Staff did not safeguard residents personal belongings:"
According to the complaint, various residents have had personal items missing. LPA interviewed residents, and two (2) indicated they have had items missing. LPA reviewed the files for these residents and did not observe personal property inventories for either resident. Management staff stated that residents who were residing at the location prior to the change of ownership did not fill out their personal property forms. Interview revealed that resident doors do lock, however residents indicated they do not lock their doors. Some residents stated they have somewhere to lock items to safeguard them in their rooms, however most residents have not requested a lock box. Staff interviewed indicated they will follow up with residents to inquire whether they would like a lock box. Staff stated frequently residents misplace items and with staff assistance, all items reported have been recovered. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260211112820

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RINCON ASSISTED LIVING	FACILITY NUMBER: 565850439
	VISIT DATE: 04/02/2026

NARRATIVE

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Allegation "Staff are allowing resident to smoke inside the facility:"
The complaint alleges a resident has been allowed to smoke inside the facility building. Interviews during the initial visit revealed some residents have seen a resident light up their cigarette in the hallway while they were walking outside to the smoking area, a few steps inside the building. It should be noted this resident was not the one reported in the complaint. LPA inquired with residents if staff were aware of this resident's behavior to which residents indicated staff were not aware, as they haven't reported it to staff. Following the initial visit, staff did approach this resident and issued a verbal warning to the resident. During the subsequent visit, LPA confirmed with the resident they have received a verbal warning and that staff do not allow residents to smoke inside. All residents interviewed stated there are rules in the facility and that smoking indoors and in non-designated areas is prohibited. No residents nor staff reported that the individual resident named in the complaint has been seen smoking inside at any time. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

Allegation "Staff are not providing adequate food service to resident:"
The complainant alleged that the food is very bland. LPA interviewed residents related to the facility food and all seven (7) of seven (7) residents interviewed are happy with the food served at the facility. LPA reviewed the facility's four (4)-week menu, which consists of a variety of foods in all food groups. Interview with staff revealed the facility does consult with a dietician, who has created the menu to be nutritionally balanced to meet the needs of the residents in the facility. All residents and staff interviewed indicated residents can always request an alternate to the menu item if they prefer. Breakfast, lunch, dinner, and three (3) snacks are served daily. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 04/02/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/02/2026

LIC9099 (FAS) - (06/04)

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