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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 10/11/2026
Date Signed: 10/11/2026 01:47:52 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
09/25/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20230925152657
FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:66CENSUS: 44DATE:
10/11/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Maria ArriagaTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Resident sustained fractures while in care due to staff neglect.
INVESTIGATION FINDINGS:
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On October 11, 2026, the California Department of Social Services/Community Care Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent unannounced complaint visit. Executive Director, Maria Arriaga, greeted the (LPA). (LPA) explained the purpose of the visit was to deliver the findings for the allegation mentioned above.

The investigation included interviews, record reviews, and a tour of the facility. Investigation conducted by Investigator M. Williams of the CDSS Investigation Branch. Interviews with Staff member S#1 - S#3 (S1-S3) and Witnesses member W#1 and W#2 (W1-W2). The Department reviewed several documents, including the Facility Resident Roster (dated 09/26/23), Facility Staff Roster (dated 09/26/23), (R1’s) Face Sheet (dated (05/13/23), Identification and Emergency Information LIC 601 (dated 03/21/23), Physician’s Report LIC 602A (dated 06/17/23), Preplacement Appraisal Information LIC 603 (dated 03/21/23), Sunshine Assessment AL/MC (dated 03/20/23), Unusual Incident/Injury Report LIC 624 (dated 06/21/23), Caleo Bay Progress Notes (dated 03/23/23 through 09/20/23), John F. Kennedy Memorial Hospital Medical Records (dated 06/20/23) and Serenity Hospice LLC records (dated 06/22/23).


Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
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 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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Allegation #1: Resident sustained fractures while in care due to staff neglect.

It is alleged that Resident (R1) sustained fractures due to staff neglect. Reports indicate that R1 suffered multiple fractures in June and August 2023. Concerns have been raised regarding these injuries, and it was reported that neither the hospice services nor the staff had access to information about these incidents. No further details have been provided regarding this matter.

Resident #1 (R1) was admitted to the Emergency Department of John F. Kennedy Memorial Hospital on June 20, 2023, following a ground-level fall in which they struck their head while walking. (R1) reported right shoulder pain and decreased mobility in that shoulder.

On February 16, 2024, February 22, 2024, and February 29, 2024, between 11:15 AM and 2:52 PM, the department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Two (2) of the (3) three staff members confirmed that Resident #1 (R1) experienced multiple falls in the facility, with one of these falls resulting in an arm fracture (S1 and S2) verified that (R1) was treated at John F. Kennedy Memorial Hospital for a fall on June 20, 2023, which resulted in a fracture of the proximal end of the right humerus. (R1) was discharged with a coaptation splint and sling and returned to the facility the same day.

(Evaluation Report continues LIC 9099-C)

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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During the interviews, (S1 and S2) reported a high staff turnover rate, which left caregiving staff overwhelmed by their workload. (S3) could only verify that (R1) was classified as receiving “mid-level” care and needed help with daily tasks and a secure environment. Even though hospice care services' medical assessment classified (R1) as a fall risk with repeated falls.

On October 19, 2023, and February 29, 2024, between 10:00 AM and 11:39 AM, the Department interviewed witnesses identified as Witness #1 and Witness #2. Two (2) of the two (2) witnesses were able to validate the claim. (W1 and W2) verified that (R1) sustained multiple falls while in care and that the fall on June 20, 2026, resulted in a fractured arm. (W1 and W2) had at least four separate falls from her admission between March 21, 2023, and September 20, 2023. (R1) was admitted as ambulatory and required a walker. However, by the time (R1) left Caleo Bay, (R1) had become non-ambulatory, was not eating, was losing weight, and had entered hospice care. (W2) indicated that since (R1) was discharged from Caleo Bay, (R1) is no longer using a wheelchair and is now using a walker, has gained weight, and, most importantly, is no longer receiving hospice care.

Resident #1 (R1) could not be interviewed because (R1) was not available.

(Evaluation Report continues LIC 9099-C)

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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The Department reviewed John F Kennedy Memorial Hospital Medical Records (dated 06/20/23) verified (R1) sustained a fracture of proximal end of right humerus. Physicians Report LIC 602A (date 06/17/23) and Serenity Hospice LLC Medical Assessment (dated 06/22/23) verified (R1) as a fall risk and loss of muscle strength and altered coordination. Caleo Bay Progress Notes (dated 03/23/23 through 09/20/23) and Unusual Incident Reports LIC 624 (dated 06/21/23) verified (R1’s) multiple falls.

Based on information collected, there is sufficient evidence to support the allegation mentioned above.

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.

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

An exit interview was conducted with Maria Arriaga, and copies of the report and appeal rights were provided.

*Immediate Civil Penalty issued*

ECP: At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(f) For a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident, the civil penalty shall be ten thousand dollars ($10,000).

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2026
Section Cited
CCR
87466
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87466 – Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance...observation reveals unmet needs… brought to the attention of the resident's physician and the resident's responsible person, if any.
This requirement is not met as evidence by:
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Licensee has agreed to a (POC). The facility will provide in-service training to all staff regarding the cited regulation. Additionally, the facility will develop a plan for residents identified as at risk of falling and submit it to the assigned LPA by 10/24/26 at ernand.dabuet@dss.ca.gov
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Based on interviews and record reviews, the facility did not ensure that (R1) received timely supervision after sustaining multiple falls and a change in condition. This poses an immediate health and safety risk to residents in care.
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Type B
10/24/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities - (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations...
This requirement is not met as evidence by:
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Licensee has agreed to a (POC). The facility will provide in-service training to all staff regarding the cited regulation. Additionally, the facility will develop a plan for residents identified as at risk of falling and submit it to the assigned LPA by 10/24/26 to ernand.dabuet@dss.ca.gov
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Based on interviews and reviews, the facility did not ensure that (R1) had a safe, healthful, and comfortable environment; (R1) is at risk for falls and, after multiple falls, did not receive adequate supervision. This poses a potential health and safety risk to residents 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: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 9
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
09/25/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20230925152657

FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE:CAZIP CODE:
92253
CAPACITY:66CENSUS: 44DATE:
10/11/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:MARIA ARRIAGATIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility staff did not provide Hospice access to residents’ records.
Staff did not communicate with authorized representative about incident to resident.
INVESTIGATION FINDINGS:
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On October 11, 2026, the California Department of Social Services/Community Care Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent unannounced complaint visit. Executive Director, Maria Arriaga, greeted the (LPA). (LPA) explained the purpose of the visit was to deliver the findings for the allegation mentioned above.

The investigation included interviews, record reviews, and a tour of the facility. Investigation conducted by Investigator M. Williams of the CDSS Investigation Branch. Interviews with Staff member S#1 - S#3 (S1-S3), four residents (R2-R5) and Witnesses member W#1 and W#2 (W1-W2). The Department reviewed several documents, including the Facility Resident Roster (dated 09/26/23), Facility Staff Roster (dated 09/26/23), (R1’s) Face Sheet (dated (05/13/23), Identification and Emergency Information LIC 601 (dated 03/21/23), Physician’s Report LIC 602A (dated 06/17/23), Preplacement Appraisal Information LIC 603 (dated 03/21/23), Sunshine Assessment AL/MC (dated 03/20/23), Unusual Incident/Injury Report LIC 624 (dated 06/21/23), Caleo Bay Progress Notes (dated 03/23/23 through 09/20/23), John F. Kennedy Memorial Hospital Medical Records (dated 06/20/23) and Serenity Hospice LLC records (dated 06/22/23).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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Allegation #2: Facility staff did not provide hospice access to resident’s records.

It is alleged that the facility staff did not provide hospice access to Resident #1's (R1’s) records. Reports indicated that hospice services could access (R1's) records upon request. No further information was available.

On February 16, 2024, October 9, 2026, and October 11, 2026, between 11:00 AM and 11:30 AM, the Department interview staff identified as Staff #1, Staff #4, and Staff #5 (S1, S4, and S5). Three (3) out of the three (3) staff members could not corroborate this claim. (S1) stated that hospice agencies receive the necessary records once the resident has consent for hospice services, and documentation confirmed that the facility released the requested information. Staff interviews were consistent in stating that hospice routinely receives care plans, medication records, and other relevant documents.

On October 11, 2022, between 11:30 AM and 12:00 PM, the Department interviewed residents identified as Resident #2 through Resident #5 (R2-R5). Four (4) out of the four (4) residents could not answer questions about this claim. Resident #1 (R1) could not be interviewed because (R1) was not available.

On October 18, 2023, and October 9, 2026, between 10:00 AM and 01:39 PM, the , the Department interviewed witnesses identified as Witness #1 and Witness #2 (W1-W2). Two (2) out of the two (2) supported this claim. (W1-W2) both encountered problems with the facility supplying (R1's) medical records. However, (W2) could not provide further details about the situation.

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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The department reviewed the resident’s file, hospice service notes, communication logs, and facility documentation of hospice requests, including John F. Kennedy Memorial Hospital Medical Records (dated 06/20/23) and Serenity Hospice LLC records (dated 06/22/23). Further review of (R1’s) service records Face Sheet (dated (05/13/23), Identification and Emergency Information LIC 601 (dated 03/21/23), Physician’s Report LIC 602A (dated 06/17/23), Preplacement Appraisal Information LIC 603 (dated 03/21/23), Sunshine Assessment AL/MC (dated 03/20/23), Unusual Incident/Injury Report LIC 624 (dated 06/21/23), and Caleo Bay Progress Notes (dated 03/23/23 through 09/20/23).

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

Allegation #3: Staff did not communicate with authorized representative about incident to resident.

It is alleged that the facility staff did not provide hospice access to Resident #1's (R1’s) records. Reports indicated that hospice services could access (R1's) records upon request. No further information was available.

On February 16, 2024, October 9, 2026, and October 11, 2026, between 11:15 AM and (put time PM), the Department interviewed staff identified as Staff #1, Staff #4, and Staff #5 (S1, S4, and S5).

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 18-AS-20230925152657
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/11/2026
NARRATIVE
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Three (3) out of the three (3) staff members could not support this claim. Staff interviews indicated that the facility’s practice is to notify the authorized representative of incidents that impact the resident’s health, safety, or well-being.(S1) reported that they contacted the authorized representative after the incident, following an internal assessment, and that attempts to notify the authorized representative are documented.

On October 11, 2022, between 11:30 AM and 12:00 PM, the Department interviewed residents identified as Resident #2 through Resident #5 (R2-R5). Four (4) out of the four (4) residents could not answer questions about this claim. Resident #1 (R1) could not be interviewed because (R1) was not available.

On October 18, 2023, and October 9, 2026, between 10:00 AM and 01:39 PM, the Department interviewed witnesses identified as Witness #1 and Witness #2 (W1-W2). Two (2) out of the two (2) supported this claim. (W1-W2) reported they were not always aware of incidents and expressed concerns about a lack of communication. A review of Caleo Bay Progress Notes (dated 03/23/23 through 09/20/23) and Unusual Incident Reports LIC 624 (dated 06/21/23) showed documentation supporting notification.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

No deficiencies were cited.

Exit interview conducted. A copy of this report was provided to Administrator Arriaga.

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

DATE: 10/11/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2026
LIC9099 (FAS) - (06/04)
Page: 9 of 9