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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800100
Report Date: 06/13/2026
Date Signed: 06/13/2026 12:02:23 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
04/29/2021 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210429134708
FACILITY NAME:GENEROUS HOMECAREFACILITY NUMBER:
331800100
ADMINISTRATOR:LIBED, MARIE ANTONETTEFACILITY TYPE:
740
ADDRESS:31963 GOLDEN WILLOW COURTTELEPHONE:
(951) 467-0366
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:6CENSUS: 2DATE:
06/13/2026
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Marie LibedTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Due to staff neglect, resident sustained multiple skin and pressure injuries.
Staff administered oxygen to resident without physician's order.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings of complaint investigation. LPA met with Facility Administrator Marie Libed.

Allegation #1 - Due to staff neglect, resident sustained multiple skin and pressure injuries.

On April 29, 2021, the Department received a complaint with allegation of personal rights violation resulting in R1 sustaining multiple skin and pressure injuries. The Department investigation consisted of review of facility and other records, observations, and interviews with pertinent individuals.

Per facility records, R1 was admitted to the facility on or around May 2019. According to physician report completed around this time, R1 did not have skin or pressure injuries. In addition, records indicated that R1 did not have capacity for self-care in areas including bathing, dressing, incontinent care, and medication administration. R1 was non-ambulatory with use of walker and needed assistance in transferring to and from bed.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
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 8
Control Number 18-AS-20210429134708
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: GENEROUS HOMECARE
FACILITY NUMBER: 331800100
VISIT DATE: 06/13/2026
NARRATIVE
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R1 admission agreement indicated services to be provided included continuous care and supervision, monitoring for resident changes in physical, mental, emotional and social functioning, assistance with daily living activities including mobility tasks, dressing, bathing, toileting, assistance with eating, and medication administration. Per interviews, on or around early January 2021, R1 had shown decline in health and had become reliant on wheelchair and being in bed more. Interviews also revealed that R1 had developed redness and then what was described as a “bed sore” was observed on coccyx area. Following observations of R1 health decline, Licensee (S1) reported that plan was to care for coccyx area, reposition R1 during the day and night, and increase hydration. Medical assessment of the area took place on or around February 12, 2021. At that time, R1 had multiple pressure injuries including Stage III wound to the left buttocks, Stage III wound to the left sacral area, and Stage III wound to the right sacral area. Despite additional instructions to facility staff to reposition R1 every 2 hours to prevent further skin breakdown, interviews revealed that repositioning did not occur as required. In addition, there was no documented written record of the care and services R1 was to receive due to changes observed.
Subsequently, R1 developed additional skin injuries. According to medical records, on or around April 2, 2021, R1 was observed to have the following injuries; Right Sacrum, Left Sacrum, Left Lower Buttocks Skin Tear, Left Ankle Deep Tissue Injury (DTI), Left Heel DTI, Right Ankle DTI. On or around April 7, 2021, medical records indicated that R1 “has a chronic lower leg ulcers and sacral pressure ulcers due to immobility that has progressed slowly and not healed spontaneously that requires surgical debridement and continued wound management.” Wound Description indicates Site 1 is a Stage III located on the Sacrococcygeal, Site 2 is a State III located on the Left Medical Gluteal, Site 3 is Chronic ulcer of skin Fat Layer Exposed located on Left Lateral Ankle, Site 4 is Chronic Ulcer of Skin Fat Layer Exposed located on Left Lateral Lower Leg.
Per Title 22 Regulations, "Pressure Injury" means localized damage to the skin and/or soft tissue under the skin that is usually over a bony part of the body or related to a medical or other device. This damage can appear as intact skin or an open ulcer and may be painful. It occurs because of intense and/or prolonged pressure on the affected part of the body or pressure combined with shear (an action or stress that causes internal parts of the body to become deformed). Based on appearance and severity, the damage to tissue is a Stage 1, 2, 3, or 4 pressure injury. According to regulations, Stage 3 pressure injuries are prohibited health conditions which shall not be accepted or retained in a residential care facility for the elderly.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 18-AS-20210429134708
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: GENEROUS HOMECARE
FACILITY NUMBER: 331800100
VISIT DATE: 06/13/2026
NARRATIVE
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Based upon Department investigation, the allegation that due to staff neglect, R1 sustained multiple skin and pressure injuries is substantiated. Facility staff did not ensure that R1 received the care needed to meet R1 needs. R1 was admitted to facility with no pressure injuries. Prior to or around January 2021, R1 had developed redness and then what was described as a “bed sore” was observed on coccyx area, but facility staff neglected to obtain assistance for care. R1 was diagnosed with multiple pressure injuries on February 12, 2021. Subsequent injuries to R1 left ankle and left lower leg were observed on or around April 7, 2021. Staff interviews revealed that R1 was not repositioned as instructed every two hours or as needed. Specifically, staff reported that R1 was repositioned every two hours during the day and one to three times during the night. However, staff also reported that if R1 was asleep staff did not “bother” R1 with repositioning or changing incontinent brief. R1 was noted to be unable to rotate position independently.

Allegation #2 - Staff administered oxygen to resident without physician's order. Investigation was conducted by Department staff. During the course of the investigation, interviews revealed that staff provided R1 with oxygen prescribed to another resident on multiple occasions. Interviews conducted with staff 2 (S2) and staff 3 (S3) confirmed that on April 18, 2021, staff 1 (S1), Administered oxygen from another resident's oxygen supply to R1. Based on the evidence gathered during the investigation the allegation of neglect and oxygen was administered to resident without physician's order. are substantiated. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence standard has been met.

In addition, an immediate civil penalty of $500.00 was assessed, per Health and Safety Code 1548 (c). Furthermore, an additional civil penalty may be imposed, per Health and Safety Code 1569.49 (f).

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 18-AS-20210429134708
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: GENEROUS HOMECARE
FACILITY NUMBER: 331800100
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/15/2026
Section Cited
CCR
87468.2(a)(4)
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87468.2 .... Additional Personal Rights of Residents in Privately Operated Facilities...(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights:....(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement is not met as evidenced by:
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The Licensee has agreed to read over regulation 87468.2(a)(4) Additional Personal Rights of Residents in Privately Operated Facilities: and provide training to all staff who provide care to residents. The licensee will also provide LPA with proof of the training signed by all participating staff acknowledging and understanding that Licensee/Staff cannot accept person’s with stage 3 and 4 pressure injuries as they are prohibited health conditions. Plan of correction will be provided on: 6/15/2026.
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Based upon review of facility and other records, observations, and interviews with pertinent individuals, licensee failed to ensure that R1 was provided with care, supervision, and services as needed. As a result, R1 sustained multiple skin and pressure injuries while at facility. This violation posed an immediate health and safety risk to residents in care.
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Type A
06/15/2026
Section Cited
CCR
87465(A)
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87465 Incidental Medical and Dental Care.... (A) Medications usually prescribed for self-administration which have been authorized by the person's physician.

This requirement is not met as evidenced by:
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The Licensee has agreed to read over regulation 87465(A) Incidental Medical and Dental Care: and provide training to all staff who provide care to residents. The licensee will also provide LPA with proof of the training signed by all participating staff acknowledging and understanding that all medications being administered must be authorized by the resident’s physician. Plan of correction will be provided on: 6/15/2026.
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Based upon review of facility and other records, observations, and interviews with pertinent individuals, licensee dispensed Oxygen to R1 without a Physician’s order. This violation posed an immediate 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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
04/29/2021 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210429134708

FACILITY NAME:GENEROUS HOMECAREFACILITY NUMBER:
331800100
ADMINISTRATOR:LIBED, MARIE ANTONETTEFACILITY TYPE:
740
ADDRESS:31963 GOLDEN WILLOW COURTTELEPHONE:
(951) 467-0366
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:6CENSUS: 2DATE:
06/13/2026
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Marie LibedTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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2
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Staff did not call 911 timely.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to the facility to deliver findings regarding the above allegation. LPA met with Facility Administrator Marie Libed and explained the purpose of the visit. The investigation consisted of interviews with relevant parties and review of facility records.

Allegation #1 Staff did not call 911 timely.

Interviews conducted during the investigation revealed that on April 18, 2021, at approximately 1500 hours, the Administrator contacted 911 after observing that Resident #1 (R1) appeared pale and was experiencing labored breathing. Facility documentation reviewed corroborated that emergency services were contacted at that time.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 18-AS-20210429134708
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: GENEROUS HOMECARE
FACILITY NUMBER: 331800100
VISIT DATE: 06/13/2026
NARRATIVE
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No information obtained through interviews or records reviewed indicated a delay in contacting emergency medical services. Based on the information gathered, there is insufficient evidence to support the allegation that staff failed to call 911 in a timely manner. Therefore, the allegation is determined to be UNFOUNDED.

This report was reviewed with Facility Administrator Marie Libed and a copy of this report was provided at the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
04/29/2021 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210429134708

FACILITY NAME:GENEROUS HOMECAREFACILITY NUMBER:
331800100
ADMINISTRATOR:LIBED, MARIE ANTONETTEFACILITY TYPE:
740
ADDRESS:31963 GOLDEN WILLOW COURTTELEPHONE:
(951) 467-0366
CITY:WINCHESTERSTATE: CAZIP CODE:
92596
CAPACITY:6CENSUS: 2DATE:
06/13/2026
UNANNOUNCEDTIME BEGAN:
09:37 AM
MET WITH:Marie LibedTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff did not ensure resident was eating.
Staff did not ensure resident was hydrated.
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 Mayra Alfaro and explained the purpose of the visit regarding the allegations stated above.

First allegation: Staff did not ensure resident was eating. Regarding the allegation stated above, LPA conducted a record review of R1 upon the review of record LPA discovered that an interview with R1 family was conducted by department staff interview indicated that R1 was being well cared for by the facility and that R1 ate well. The interview further stated that R1 body was not observing its nutrients due to R1 kidney condition. LPA conducted interviews with Staff #1 and Staff #2 regarding the allegation stated above and S1 and S2 denied the allegation and informed LPA that R1 was on a pureed diet and was being fed by staff. LPA conducted an inspection on facility food supply during the inspection LPA observed non-perishable and perishable food supply to be sufficient for the number of residents in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 18-AS-20210429134708
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: GENEROUS HOMECARE
FACILITY NUMBER: 331800100
VISIT DATE: 06/13/2026
NARRATIVE
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Second allegation: Staff did not ensure resident was hydrated. Regarding the allegation stated above, LPA conducted a record review of R1 upon the review of record LPA discovered that an interview with R1 family was conducted by department staff interview indicated that R1 was being well cared for and the family had no concerns regarding the care being provided to R1. LPA conducted interviews with Staff #1 and Staff #2 regarding the allegation stated above and S1 and S2 denied the allegation and informed LPA that R1 was maintained hydrated by staff and fluids to R1 were being provided daily. In addition, S1 and S2 informed LPA that any significant changes to R1 condition or refusals were being communicated to R1 responsible party. Based on corroborating evidence LPA has determined that the above allegation is 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 Marie Libed
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2026
LIC9099 (FAS) - (06/04)
Page: 8 of 8