198601553-4-25-2025-28-AS-RORN-DGWP4N-20250522105925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601553
Report Date: 04/25/2025
Date Signed: 04/25/2025 05:54:44 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2025 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250424084718

FACILITY NAME:	CALIFORNIA MENTOR - MEADCLIFF HOME		FACILITY NUMBER:	198601553
ADMINISTRATOR:	CHRIS SCHLANSER		FACILITY TYPE:	734
ADDRESS:	23612 MEADCLIFF PLACE		TELEPHONE:	(909) 274-7620
CITY:	DIAMOND BAR	STATE: CA	ZIP CODE:	91765
CAPACITY:	5	CENSUS: 5	DATE:	04/25/2025
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Riza Porciuncula, Staff		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not provide proper transfer assistance to client in care resulting in injuries.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced with Nurse, Riza Porciuncula, and explained the purpose of the visit.
During today’s visit, LPA toured the facility and interviewed the administrator, staff, and clients. LPA obtained copies of the staff roster, client roster, and staff training log.

Allegation - Staff did not provide proper transfer assistance to client in care, resulting in injuries. It was reported that Client #1 (C1) slid off the sling during transfer and landed on the floor, which resulted in a small cut to the forehead and left forearm redness. LPA interviewed the Administrator and Staff #1 - #5. The administrator and staff acknowledged the incident that occurred on 2/28/25, in which C1 slid off the sling. However, Staff #1 and #2, who were assisting C1 at that time, stated C1 was caught right away and did not hit the ground.

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250424084718

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CALIFORNIA MENTOR - MEADCLIFF HOME	FACILITY NUMBER: 198601553
	VISIT DATE: 04/25/2025

NARRATIVE

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The RN immediately checked C1’s vitals and for any bruises or injuries. C1 received a small scratch on the forehead and a scratch and redness on the arm. Staff stated they followed the proper procedures in securing the client to the sling. The physician was notified, and the incident was reported to the appropriate agencies. Staff interviewed stated they all receive annual training on transferring, lifting, and utilizing the Hoyer lift. They are following proper procedures to safely transfer all the clients, which includes 2 persons assist at all times. LPA obtained copies of recent training on the topic of safe lifts and transfers.

LPA interviewed 2 clients and attempted to interview Client #1. Client #1 is non-verbal and unable to respond to LPA’s questions. The other 2 clients like living at the facility and think the staff handle them carefully.

The regional center also investigated this allegation and did not find any neglect or form of abuse coming from the facility staff.

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, therefore, the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Staff T. Bravo. A copy of this report, along with the appeal rights, was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025

LIC9099 (FAS) - (06/04)

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