198602895-4-22-2021-28-AS-CYEE-CD5V4E-20220403160612

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602895
Report Date: 04/22/2021
Date Signed: 04/22/2021 04:04:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/16/2021 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20210416131628

FACILITY NAME:	CLAREMONT PLACE		FACILITY NUMBER:	198602895
ADMINISTRATOR:	HUNT, LISA		FACILITY TYPE:	740
ADDRESS:	120 SAN JOSE AVE		TELEPHONE:	(909) 447-5259
CITY:	CLAREMONT	STATE: CA	ZIP CODE:	91711
CAPACITY:	93	CENSUS: 72	DATE:	04/22/2021
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Administrator, Nicole Vasquez		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff are not adequately trained
Facility staff falsified records

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Linda Almaraz and Alberto Lopez initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this complaint investigation was conducted telephonically with Nicole Vasquez Administrator.

The investigation consisted of the following: LPA interviewed Vasquez and Staff #1-9. LPA also requested resident and staff rosters, Resident Care notes and Checklist, and Caregiver training records.

The investigation revealed the following: Regarding allegation "Staff are not adequately trained," based on interviews conducted all staff use a system called Relias Learning Management System where they take required training's for their position. LPA learned all staff members have their own user name/password and are expected to take their own training. (Continued on LIC-9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

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-20210416131628

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: CLAREMONT PLACE	FACILITY NUMBER: 198602895
	VISIT DATE: 04/22/2021

NARRATIVE

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It was alleged that staff members were taking tests for each other and were not properly trained due to not taking their own training. Based on interviews conducted with staff, no one has taken a test for each other and have not seen or heard of anyone else take a test for another person. Interviews also revealed if staff have any issues or questions they have to ask a supervisor or the Nurse in charge for assistance. LPA reviewed training records for Staff #6 and #7 and found no discrepancies.

Regarding allegation "Facility staff falsified records," it is alleged that caregivers were not completing their daily checklist's used to document residents completed ADL's and other staff were going back to previous weeks and falsifying records. During interviews with staff, all nine (9) staff indicated they are required to complete the checklist by the end of their shift and can't have another staff fill out the checklist for them. Staff indicated they have never seen anyone complete a checklist for someone else or for them. LPA also learned when a staff forgets to complete their checklist, the Med-tech on duty will remind that day or the following day to complete their checklist. According to interviews conducted none of the staff have gone back to weeks or months prior to complete their checklist. LPA reviewed checklist's and resident care notes completed by staff and found no discrepancies.

Based on LPA's interviews conducted and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted via telephone with the Administrator and a hardcopy was provided via email for signature. Signatures on hardcopy.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

LIC9099 (FAS) - (06/04)

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