331800081-11-29-2022-18-AS-JESL-CLNUWP-20221130145705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800081
Report Date: 11/29/2022
Date Signed: 11/29/2022 10:03:42 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/12/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201112124219

FACILITY NAME:	BUSMAN RESIDENTIAL CARE LLC		FACILITY NUMBER:	331800081
ADMINISTRATOR:	READE, JOHN		FACILITY TYPE:	740
ADDRESS:	27892 BUSMAN ROAD		TELEPHONE:	(951) 888-9512
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 5	DATE:	11/29/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	John Reade - Administrator		TIME COMPLETED:	09:45 AM

ALLEGATION(S):

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Staff caused injury to resident

Staff handled resident in a rough manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of delivering findings on the complaint with the above allegation. LPA Colvin met with Administrator John Reade and advised them of the purpose of today's visit. Below is a summary of the findings discussed:

Regarding allegation "Staff caused injury to resident": Department staff conducted interviews with staff and reviewed facility file and hospice paperwork for Resident #1 (R1). Record review and interviews revealed that R1 requires maximum assistance with all activities of daily living (ADLs), which includes assistance with transferring. Hospice records show only a bruise to R1’s arm, first observed on October 2, 2020. LPA Colvin additionally verified that R1 was taking prescribed blood thinning medication twice daily, which according to hospice notes, could potentially cause the resident to bruise more easily. LPA Colvin was unable to interview R1 due to R1 passing away while the investigation was still open. There is insufficient evidence to support the claim of physical abuse, and therefore, the allegation “Staff caused injury to resident” is UNSUBSTANTIATED. .

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

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 18-AS-20201112124219

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: BUSMAN RESIDENTIAL CARE LLC	FACILITY NUMBER: 331800081
	VISIT DATE: 11/29/2022

NARRATIVE

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Regarding allegation "Staff handled resident in a rough manner": Department staff conducted interviews with staff and reviewed facility file and hospice paperwork for Resident 1 (R1). The complaint allegation was specific to Staff 1 (S1), but interviews conducted with facility staff deny S1 ever working at the facility. LPA Colvin observed that S1 is associated to the facility and pulled a contact number for them from the Guardian System. LPA Colvin was unsuccessful in getting a hold of S1 through the number available, and similarly, LPA Colvin was unable to interview R1 due to R1 passing away during this investigation. Therefore, due to lack of evidence to support the claim, the allegation “Staff handled resident in a rough manner” is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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 with Administrator John Reade and a copy of this report was provided.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 11/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC9099 (FAS) - (06/04)

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