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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881452
Report Date: 08/04/2026
Date Signed: 08/04/2026 06:35:10 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
08/04/2026 and conducted by Evaluator Ivashia Wright
COMPLAINT CONTROL NUMBER: 18-AS-20260804150117
FACILITY NAME:SENIOR ASSISTED LIVING AT VINTAGE RESERVE LLCFACILITY NUMBER:
331881452
ADMINISTRATOR:BARROSO, MARIBELFACILITY TYPE:
740
ADDRESS:40147 GRENACHE COURTTELEPHONE:
(951) 719-0270
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
08/04/2026
UNANNOUNCEDTIME BEGAN:
02:42 PM
MET WITH:Pedro Barroso, AdministratorTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Facility is not operating within the scope of their license
INVESTIGATION FINDINGS:
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On August 4, 2026, Licensing Program Analyst (LPA) Ivashia Wright conducted an unannoced visit to the facility to investigate the above allegation. The LPA introduced themselves and explained the purpose for the visit. During the visit, LPA toured the Facility, reviewed and obtained pertinent documentation, and interviewed staff and residents.

Regarding the allegation that Facility is not operating within the scope of their license, it was reported that six (6) of six (6) residents are bedridden. After reviewing the facility's fire clearance it was observed that the facility never did receive a fire clearance for bedridden residents.

Cont on LIC 9099c
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ivashia Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
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-20260804150117
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: SENIOR ASSISTED LIVING AT VINTAGE RESERVE LLC
FACILITY NUMBER: 331881452
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/05/2026
Section Cited
CCR
87202(a)2
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87202 FIRE CLEARANCE (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department... Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate
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The adiministrator will provide a eviction notice according to regualtions for R1 and R2 to CCLD by 5pm on 8/5/2026.
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fire clearance approved by the city, county, or city and county fire department...This requirement is not met as evidenced by: (2) of (6) residents are bedridden and there is no bedridden fire clearance.
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Type B
08/12/2026
Section Cited
CCR
81068.2(a)
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81068.2 Needs and Services Plan: (a) The licensee shall complete a Needs and Services Plan for each client as required in Sections 81068.2, 82068.2, 82568.2, 84068.2, or 85068.2.
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The administrator will provide copies of Needs and Services Plan for each resident to CCLD by 8/12/2026 5pm.
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This requirement is not met as evidenced by: Resident's records review revealed zero (0) out of the six (6) residents have a Needs and Service Plan.This poses a potential health risk to clients 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.
SUPERVISOR'S NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ivashia Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20260804150117
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: SENIOR ASSISTED LIVING AT VINTAGE RESERVE LLC
FACILITY NUMBER: 331881452
VISIT DATE: 08/04/2026
NARRATIVE
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Information obtained from interview with staff stated majority of the residents are bedridden. Information obtained from review of R1's 602's indicated the resident is bedridden and has been admitted to the facility since 3/9/2026. Information obtained from review of R2's 602 indicated the resident is bedridden and has been admitted to the facility since 11/9/2023. Therefore, the two residents #1 and #2, identified during todays visit as being bedridden will need to be relocated to a facility that has a bedridden fire clearance.

Based on witness interviews, staff interviews, facility records, and LPA observations, the allegation that Facility is not operating within the scope of their license is deemed substantiated. A substantiated finding means that the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated.

A copy of this report, LIC9099C, LIC 9099D, LIC 421FC, and appeal rights are being provided to Pedro Barroso.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Ivashia Wright
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3