336427578-6-17-2026-18-AS-PMAA-DVBSY8-20260623141708

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336427578
Report Date: 06/17/2026
Date Signed: 06/17/2026 02:04:59 PM

Unsubstantiated

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
01/26/2024 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20240126084430

FACILITY NAME:	FOOTHILL LAKE HOME		FACILITY NUMBER:	336427578
ADMINISTRATOR:	ANGELITO V. MENDOZA		FACILITY TYPE:	740
ADDRESS:	24746 MORNING MIST DRIVE		TELEPHONE:	(951) 208-1722
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	6	CENSUS: 3	DATE:	06/17/2026
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Julita Mendoza		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure resident in care was provided with adequate transportation services.
Staff is forcing resident in care to leave the facility.

INVESTIGATION FINDINGS:

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On June 17, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint visit. The LPA met with the Administrator, Julita Mendoza (A1), and explained the purpose of the visit.

The complaint investigations consisted of the following. On June 1, 2026, the Department obtained various documents, including the Personnel Report LIC 500 (dated 06/17/26) and the Client Roster (dated 06/17/26). The Department reviewed and collected documents for Resident 1 (R1), including the face sheet dated 12/23/2023, the Admission Agreement dated 01/05/2024, the physician's Report dated 01/08/2024, and the Medications list dated 01/05/2024. The Department interviewed the Administrator (A1), 2 staff members (S1 and S2), and 1 resident (R2), and attempted to interview 2 additional residents (R3 and R4). The Department was unable to interview Resident 1 (R1) because R1 moved out of the facility on 03/02/2024. The Department requests a copy of the Unusual Incident Report (UIR) dated 03/02/2024.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

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 4

Control Number 18-AS-20240126084430

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: FOOTHILL LAKE HOME	FACILITY NUMBER: 336427578
	VISIT DATE: 06/17/2026

NARRATIVE

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Allegation #1: Staff did not ensure resident in care was provided with adequate transportation services.

The complaint alleged that staff failed to arrange transportation for a resident (R1) due to R1's disabilities. On January 31, 2024, the department interviewed the Hospice worker (HW), who stated that there were no concerns regarding adequate transportation services for R1. The department also interviewed the placement agency (PA) on the same day; PA denied the allegation and asserted that transportation was provided without issue.

Additionally, on January 31, 2024, the department spoke with three staff members (S1-S3), all of whom denied the allegation. They indicated that during R1's admission, it was made clear that transportation was not part of the services the facility would provide.

On June 17, 2026, the department interviewed the Administrator (A1), who also denied the allegation. A1 stated that transportation to medical appointments was discussed during the client's admission to the facility. A1 mentioned that R1 was seen by Hospice Care once a week and that the Certified Home Health Aide (CHHA) visited the client three times a week. If R1 needed transportation, the CHHA would organize it.

On June 17, 2026, the department interviewed two other staff members (S1 and S2), who reiterated that the facility does not provide transportation for hospice clients.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20240126084430

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: FOOTHILL LAKE HOME	FACILITY NUMBER: 336427578
	VISIT DATE: 06/17/2026

NARRATIVE

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However, during the same the department interviewed one resident (R2) who stated that the facility provides transportation and even takes R2 shopping upon request. The department attempted to interview two additional residents (R3 and R4) on June 17, 2026, but was unable to do so due to their health conditions. On June 17, 2026, the department's review of the admission agreement in the Basic Services, part #7, indicated that the facility will not provide transportation services; residents are responsible.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation (s) did or did not occur; therefore, the allegation is Unsubstantiated.

Allegation #2: Staff is forcing a resident in care to leave the facility.

The complaint alleged that if the resident (R1) could not pay, R1 would have to leave the facility by January 26, 2024. On January 31, 2024, the department interviewed R1, who denied the allegation and stated that R1 wanted to move out of the facility to obtain full-time care-giving with help from the Veterans Administration (VA). R1 also expressed a desire not to live in a shared room.

On the same day, January 31, 2024, the department interviewed the Placement Agency (PA), which also denied the allegation. The PA stated that R1 had requested relocation to another facility because of a desire for 24-hour care. The PA also stated that resources were available and that relocation would occur once the process was completed.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20240126084430

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: FOOTHILL LAKE HOME	FACILITY NUMBER: 336427578
	VISIT DATE: 06/17/2026

NARRATIVE

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On June 17, 2026, the department interviewed the Administrator (A1), who denied the allegations and stated that R1 was unwilling to pay the full rent. On March 2, 2024, R1 called a Medical Emergency (ME) service for transport to a hospital and did not return to the facility afterward. A1 reported that they had contacted the Placement Agency regarding this incident. During the same interview, the department also interviewed two other staff members (S1 and S2), who denied that the facility would force residents to move out. A review of the facility notes confirmed that R1 went to the hospital on March 2, 2024, and did not return to the facility.

No deficiencies were cited.

An exit interview was conducted, and a copy of the report was provided to the Administrator, Julita Mendoza.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 06/17/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2026

LIC9099 (FAS) - (06/04)

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