MOUNTAIN SHADOWS SPECIAL KIDS HOMES-MAVERICK HOUSE
ICF/DD-N (Nursing) · 6 licensed beds · Riverside, CA
Homes of 4–15 beds for medically fragile people with developmental disabilities who need intermittent skilled nursing.
Address
MOUNTAIN SHADOWS SPECIAL KIDS HOMES-MAVERICK HOUSE8163 LAUREL PARK CIRRiverside, CA 92509 · Riverside CountyPhone: (760) 743-3714
State penalties
2
Class 2 B
Federal surveys
23
since 2018 · 14 with deficiencies
Federal deficiencies
54
none condition-level
Last federal survey
Apr 9, 2026
survey date
Facility details
- Facility type
- ICF/DD-N (Nursing)
- Licensed beds
- 6
- Licensee
- MOUNTAIN SHADOWS SUPPORT GROUP · Nonprofit Corp
- Administrator
- ERASEREN, SERRIA C
- CDPH facility ID
- 250001290
- License number
- 250000539
- First licensed
- February 7, 1994
- Current license
- May 23, 2026 to May 22, 2027
- CDPH district office
- Riverside
Federal certification (CMS)
- CMS Certification Number (CCN)
- 05G734
- Status in CDPH's listing
- Licensed And Certified
- Program
- Medi-Cal (Medicaid, Title XIX)
- Participating since
- February 15, 1994
- Last certification survey
- September 30, 2025
- CMS certification status
- Certified
- In compliance (CMS)
- Yes
- Last certification action
- Recertification
- Ownership type (CMS)
- Private (proprietary)
- Certified beds (CMS)
- 6
- Staffing reported to CMS
- RN 1 · LVN/LPN 2 · direct care 11 · all employees 14
State citations and penalties (CDPH)
CDPH issues citations under Health and Safety Code §1424: Class AA (a violation that was a substantial factor in a resident's death), Class A (imminent danger or a substantial probability of death or serious harm) and Class B (a direct relationship to residents' health, safety or security). State citations explained
Class BAbuse/Facility Not Self Reported
Citation - B · Violations: 1418.91(b), T22 DIV5 CH8 ART4-76521(a), 483.420(d)(2), 1418.91(a) · Violation Jan 15, 2024 · Penalty #250019932 · Survey J22211
Status: Closed · Not appealed
$1,000
Citation document ↗Class BAbuse/Facility Not Self Reported
Citation - B · Violations: 483.420(d)(2), 1418.91(a), 1418.91(b), T22 DIV5 CH8 ART4-76521(a) · Violation Jan 17, 2024 · Penalty #250019933 · Survey BSUV11
Status: Closed · Not appealed
$1,000
Citation document ↗
Federal inspections (CMS-2567)
CDPH surveys certified ICFs for CMS. Each deficiency is a W-tag (a federal ICF/IID requirement), an E-tag (emergency preparedness) or a K-tag (Life Safety Code), cited at the standard level or, more seriously, the condition level. How to read an ICF inspection
Content note: these federal findings describe residents' care and can include abuse, neglect, injuries and medical details. They're shown as CMS published them; residents are identified only by number (such as "Client 1").
· Complaint
Event 22DE32-H1 · no deficiencies cited
· Complaint
Event 6TON11 · no deficiencies cited
· Complaint
Event 3TYK11 · no deficiencies cited
· Complaint
Event KU2V11 · no deficiencies cited
From CMS's QCOR ICF/IID statement-of-deficiency download, saved Oct 26, 2026. CMS notes that ICF/IID data after March 19, 2026 may be incomplete while its systems migrate. Plans of correction and state-only (licensing) deficiencies aren't in that file; the official 2567 documents on CalHealthFind have them.
Complaints and reported incidents
CDPH doesn't publish complaints or facility-reported incidents as a bulk file, so they aren't on ICFLookup. Its CalHealthFind page for this facility lists them (intake date, allegation category and whether each was substantiated), along with state licensing deficiencies and ownership details.
Federal surveys that came from a complaint or an incident report do appear above, marked "Complaint" as the survey type.
Open this facility on CalHealthFind ↗How to file a complaint with CDPH
Change history
26 events, newest first
Dates marked "state record" are the agencies' own: the license date, federal survey dates and penalty issue dates. "Detected" changes are ones we noticed by comparing CDPH's monthly facility listing with the one before it, tracked since Oct 26, 2026.
ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (complaint): 2 deficiencies(state record)
See this survey →ReportFederal survey (recertification): 3 deficiencies(state record)
See this survey →ReportFederal survey (recertification): 4 deficiencies(state record)
See this survey →ReportFederal survey (complaint): no deficiencies(state record)
See this survey →ReportFederal survey (recertification): 5 deficiencies(state record)
See this survey →ReportFederal survey (recertification): 7 deficiencies(state record)
See this survey →ReportState Class B citation ($1,000)(state record)
See this citation →ReportState Class B citation ($1,000)(state record)
See this citation →ReportFederal survey (complaint): 1 deficiency(state record)
See this survey →
Sources: CDPH Licensed and Certified Healthcare Facility Listing (data as of Oct 16, 2026), CDPH State Enforcement Actions, and CMS's ICF/IID statement-of-deficiency (CMS-2567) and Provider of Services files. ICFLookup is not affiliated with CDPH or CMS; always confirm with CDPH's CalHealthFind ↗ before making a decision. See How our data works.