<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881430
Report Date: 10/10/2026
Date Signed: 10/10/2026 04:55:17 PM

Substantiated


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
03/25/2026 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20260325161852
FACILITY NAME:CASA DEL SOL RESIDENTIALFACILITY NUMBER:
331881430
ADMINISTRATOR:KHAN, MUSARRATFACILITY TYPE:
740
ADDRESS:27830 BRODIAEA AVENUETELEPHONE:
(909) 282-2316
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:6CENSUS: 5DATE:
10/10/2026
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:KHAN MUSARRATTIME COMPLETED:
05:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek timely medical attention for resident who fell and sustained a fracture.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On October 10, 2026, Licensing Program Analyst (LPA) Antonine conducted an unannounced follow-up visit to Casa Del Sol Residential to deliver findings on the complaint allegation. LPA met with the Administrator (A1) Musarrat Khan and explained the purpose of the visit.

The investigation included the following: On March 27, 2026, the department reviewed resident R1's records, including the Unusual Incident Report, facility notes (dated February 2 to March 24, 2026), hospice records (dated March 03 to 31, 2026), and the RUHS discharge summary dated April 1, 2026. Interviews were conducted with the Administrator (A1); three staff members (S1–S3); three residents (R2–R4); the Hospice Director (HD); the hospice Licensed Vocational Nurse (LVN); and a family member (W1).

Report continued on LIC9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
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 6
Control Number 18-AS-20260325161852
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: CASA DEL SOL RESIDENTIAL
FACILITY NUMBER: 331881430
VISIT DATE: 10/10/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff did not seek timely medical attention for resident who fell and sustained a fracture.

The complaint alleged that staff did not seek timely medical attention for a resident (R1) who fell and suffered a fracture. Facility records indicated that on March 11, 2026, staff found R1 on the floor in their room at approximately 6:30 AM. The facility then notified hospice; a licensed vocational nurse (LVN) who assessed R1 around noon, recommending bed rest and pain medication.

On March 14, 2026, the Administrator (A1) contacted hospice LVN to request an X-ray for R1. Over the following days, the facility and hospice LVN communicated about obtaining the X-ray due to R1's ongoing pain. An X-ray was scheduled for March 22 and March 23, 2026, but no technician arrived on either date.

Report continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20260325161852
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: CASA DEL SOL RESIDENTIAL
FACILITY NUMBER: 331881430
VISIT DATE: 10/10/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On March 24, 2026, because of the persistent pain and the missed X-ray, the Administrator (A1) decided to send R1 to Riverside University Health System (RUHS). Medical records showed that R1 was admitted with a right intertrochanteric fracture, a left intertrochanteric femoral fracture requiring intramedullary fixation, and acute pain. R1 underwent surgery on March 26, 2026. Staff interviews revealed that R1 had experienced two falls earlier in the month, but no visible trauma had been observed at that time.The department interviewed the Hospice Director, who reported that the facility had not consistently communicated with hospice about pain management. The department also interviewed a family member (W1), who stated that they frequently visited R1 and noticed a decline in R1's condition following a fall on March 11, 2026. Additionally, the department spoke with three residents (R2-R4); however, R2 and R3 declined to answer questions. R4 mentioned that they had no concerns about the care provided. On June 23, 2026, the department interviewed the Administrator (A1), who relayed that during a conversation with the hospice. LVN, the LVN indicated that even if a fracture were identified, R1 would not be transported to the hospital because R1 was receiving hospice care.

Report Continued on LIC9099C.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20260325161852
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: CASA DEL SOL RESIDENTIAL
FACILITY NUMBER: 331881430
VISIT DATE: 10/10/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On March 17, 2026, A1 observed that staff were repositioning Resident 1 (R1) and saw that R1 was in pain. However, the facility did not contact emergency services (911) for R1.

The department interviewed three staff members (S1-S3). S1 reported that they found R1 on the floor in R1's room on March 11, 2026. S2 stated that R1 was considered a fall risk after the first fall. S3 mentioned having limited knowledge of the incident on March 11, 2026. The department was unable to interview R1 directly.

The department reviewed the emergency department record from RUHS dated March 24, 2026, which indicated that R1 was admitted for a closed right intertrochanteric fracture (hip fracture) and a left intertrochanteric femoral fracture, with intramedullary fixation (a broken left thigh bone near the hip joint), along with acute pain. On March 26, 2026, R1 underwent surgery. R1 was discharged from RUHS on April 1, 2026, following the surgery.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED

Report continued on LIC9099C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20260325161852
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: CASA DEL SOL RESIDENTIAL
FACILITY NUMBER: 331881430
VISIT DATE: 10/10/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A $500 immediate civil penalty was assessed, and the licensee was informed that additional enhanced civil penalties may apply under Health and Safety Code sections 1569.4

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiencies were observed, and citation issued (ref. LIC 9099D).

*Immediate Civil Penalty issued*

Exit interview conducted. A copy of this report and Appeal rights were provided to the Administrator Musarrat Khan.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20260325161852
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: CASA DEL SOL RESIDENTIAL
FACILITY NUMBER: 331881430
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2026
Section Cited
CCR
87469(c)(3)
1
2
3
4
5
6
7
87469.(c)(3)If a resident who has an advance directive and/or request regarding resuscitative measures form on file experiences a medical emergency, facility staff shall do one of the following3) Specifically for a terminally ill resident that is receiving hospice services and has completed an advance directive and/or request regarding resuscitative measures form pursuant to Health and Safety Code section 1569.73(c), and is experiencing a life-threatening emergency as displayed by symptoms of impending death that is directly related to the expected course of the resident’s terminal illness, the facility may immediately notify the resident’s hospice agency in lieu of calling emergency response (9-1-1). For emergencies not directly related to the expected course of the resident’s terminal illness, the facility staff shall immediately telephone emergency response (9-1-1).

1
2
3
4
5
6
7
The licensee will train all staff to call Medical Emergency (911) when a fall occurs, even if the resident is receiving hospice services. The licensee will email the POC to LPA at Antonine.richard@dss.ca.gov.
8
9
10
11
12
13
14
Based on the hospital records, facility notes, hospice records, and interviews, the licensee did not comply with the section cited above. The licensee did not provide adequate care and supervision after R1 fell on 03/11/2026, until 13 days after R1 fell. This poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6