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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425024
Report Date: 08/24/2026
Date Signed: 08/24/2026 03:02:50 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/06/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260206102323
FACILITY NAME:CHINO HILLS SENIOR LIVINGFACILITY NUMBER:
366425024
ADMINISTRATOR:JULIE (OLMEDO) DIONFACILITY TYPE:
740
ADDRESS:6500 BUTTERFIELD RANCH RDTELEPHONE:
(909) 606-2553
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:94CENSUS: 70DATE:
08/24/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Tamra Pich TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff failed to obtain immediate medical services.
Staff mishandled a resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Tamra Pich and explained the purpose of the visit regarding the allegation stated above. Investigation was conducted by department staff which included review of records and witness interviews.

Based on the evidence, Resident 1 (R1)’s assessment dated July 18, 2025, shows that R1 did not require additional status checks and only needed standby assistance with transfers. R1 was also identified as a fall concern. Hospice services were initiated on July 4, 2025, and a physician’s report dated August 14, 2025, noted that R1 lacked hazard awareness and was a fall risk due to an unsteady gait and poor foot balance.
On November 18, 2025, R1 experienced an unwitnessed fall and was found on the hallway floor yelling for help. The Med-Tech observed no injuries and assisted R1 back into resident wheelchair.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
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 5
Control Number 56-AS-20260206102323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CHINO HILLS SENIOR LIVING
FACILITY NUMBER: 366425024
VISIT DATE: 08/24/2026
NARRATIVE
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The following day, November 19, 2025, R1 sustained a witnessed fall and complained of pain when left leg was moved. Records indicate that Tylenol and Ativan were administered, and Ibuprofen was given for pain. However, 911 was not called, despite facility protocol requiring emergency services when a resident reports pain after a fall. On November 20, 2025, x rays revealed a left acetabulum fracture, and Norco was prescribed for pain management.Based on the evidence facility did not seek immediate medical attention after R1 sustained a fall and complained of severe pain and was only provided with Ibuprofen for pain management.

Second allegation: Staff mishandled a resident's medications. Regarding the allegation stated above, LPA conducted a record review of R1's file. During the review of records, LPA found that on 11/19/2025, R1 sustained a fall and subsequently complained of pain. On 11/20/2025, records indicate that R1 was administered 600 mg of Ibuprofen instead of Tylenol for pain management. The medication administration record documented the result as "semi-effective." Additionally, records indicate that R1 was administered Diclofenac Sodium 1% gel for left knee and hip pain. The documented result of the medication was "not effective." On 11/24/2025, records indicate that R1 was administered Hydrocodone-Acetaminophen for pain. The documented effectiveness of the medication was listed as "unknown." Based on the review of R1's records, LPA found documentation indicating that R1 received multiple pain medications following the fall, with some medications documented as semi-effective or not effective in managing R1's reported pain. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 Regulations, from division 6, chapter, article 6, is, cited on the attached LIC 9099 D. An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Administrator Tamara Pitch.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20260206102323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CHINO HILLS SENIOR LIVING
FACILITY NUMBER: 366425024
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/25/2026
Section Cited
CCR
87465(2)
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Incidental Medical and Dental Care 87465 (2) The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the residents’ need. In providing transportation the licensee shall do so directly or make arrangements for this service.

This requirement is not met as evidence by:
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The Licensee has agreed to read regulation: 87465 (2) and provide training to all care staff. The licensee will provide LPA with proof of training signed and dated by all staff by POC 8/25/2026.
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Based on observation, record review, the Licensee did not adhear to the regulation stated above by not providing R1 with immidate medical assistance, which poses an immediate health, safety, or personal rights risk to residents in care.
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Type A
08/25/2026
Section Cited
HSC
87468.1(a)(2)(3)(8)
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Personal Rights of Residents in All Facilities 87468.1 …. (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, furnishings and equipment…. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination…. (8) Deny or restrict medical or nonmedical care that is appropriate to a resident’s organs and bodily needs or provide medical or nonmedical care to the resident in a manner that, to a similarly situated reasonable perneeds orly demeans the resident’s dignity or causes avoidable discomfort.

This requirement is not met as evidence by:
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The Licensee has agreed to read regulation: 87468.1(a)(2)(3)(8) and provide training to all care staff. The licensee will provide LPA with proof of training signed and dated by all staff by POC 8/25/2026.
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Based on observation, record review, the Licensee did not adhear to the regulation stated above by not providing R1 with adequate and responsive pain medication to help treat R1 pain, which poses an immediate health, safety, or personal rights 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: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
02/06/2026 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260206102323

FACILITY NAME:CHINO HILLS SENIOR LIVINGFACILITY NUMBER:
366425024
ADMINISTRATOR:JULIE (OLMEDO) DIONFACILITY TYPE:
740
ADDRESS:6500 BUTTERFIELD RANCH RDTELEPHONE:
(909) 606-2553
CITY:CHINO HILLSSTATE:CAZIP CODE:
91709
CAPACITY:94CENSUS: 70DATE:
08/24/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Tamara Pitch TIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Staff neglect resulted in a resident's death.
Staff did not provide adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Tamara Pitch and explained the purpose of the visit regarding the allegations stated above.

First Allegation: Staff Neglect Resulted in a Resident's Death. Regarding the allegation stated above, LPA conducted a record review of R1's file pertaining to the allegation. During the record review, LPA found that R1 was admitted to Bright Haven Hospice on 09/26/2025 with a terminal diagnosis of End-Stage (E/S) Heart Disease. R1 was also diagnosed with dementia, atherosclerosis, hypertension, atrial fibrillation (A-Fib), a history of falls, and urinary tract infections (UTIs). LPA reviewed R1's death certificate and found that the primary cause of death was documented as congestive heart failure. Based on the review of R1's records and death certificate, LPA did not find evidence indicating that staff neglect contributed to R1's death.

Second Allegation: Staff Did Not Provide Adequate Food Service.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20260206102323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CHINO HILLS SENIOR LIVING
FACILITY NUMBER: 366425024
VISIT DATE: 08/24/2026
NARRATIVE
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Regarding the allegation stated above, LPA conducted an inspection of the facility's food supply. During the inspection, LPA observed that the facility had an adequate supply of food and snacks to meet the needs of the residents in care. LPA also found that the facility receives food deliveries twice a week, on Mondays and Friday’s, from US Foods. LPA conducted interviews with Residents #2 through #6. Residents #2 through #6 stated that the food provided by the facility was satisfactory. Residents also reported that the facility provides snacks and that they had no concerns regarding the food provided by the facility. Based on the inspection of the facility's food supply and interviews with Residents #2 through #6, LPA did not find evidence to substantiate the allegation that the facility failed to provide adequate food service. LPA has determined that the above allegations are Unsubstantiated, meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Tamara Pitch
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5