331800081-11-29-2022-18-AS-TDAN-D4U6HQ-20240430204955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800081
Report Date: 11/29/2022
Date Signed: 11/29/2022 10:15:19 AM

Substantiated

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
04/02/2021 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210402150356

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:	09:45 AM
MET WITH:	John Reade - Administrator		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident's were left unattended.

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 "Resident's were left unattended": The Department conducted interviews with staff, residents, and other persons who witnessed the above allegation. While Licensee John Reade denied the allegation and stated that he was present in the backyard of the facility on 3/31/21, other statements obtained contradict this information. Other statements obtained through interviews relay that either John and his wife were out of town in Tijuana during the date this took place, or that Licensee John was next-door at an unlicensed location. In all statements obtained, including that of Licensee John, all persons agree that someone by the name of "Mark" was present inside the facility. Statements from Licensee John changed regarding "Mark"'s relationship to the facility (employee versus someone helping with cooking) and Licensee never provided LPAs with contact information or full name of "Mark" for further investigation

Substantiated

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-20210402150356

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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LPAs additionally addressed with Licensee that there was no one by the name of "Mark" associated to the facility at the time of the investigation, and Licensee did not have an employee file for this individual. Therefore, since statements agree that "Mark" was the only person other than residents inside the facility on 3/31/21, and the majority of interviews state that there were no other persons besides residents present at facility while "Mark" was there, and there are no employee documents for "Mark", the allegation "Resident's were left unattended" is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. This deficiency is regarded in Health & Safety Code as a serious deficiency which results in an immediate civil penalty of $500, which LPA Colvin will be assessing today. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, LIC421IM, and appeal rights were provided to Administrator John Reade during the exit interview.

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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Control Number 18-AS-20210402150356

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/29/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/30/2022 Section Cited CCR 80065(A)	1 2 3 4 5 6 7	Personnel Requirements: (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to review Title 22 Regulation section regarding Personnel Requirements (80065) as well as Criminal Record Clearance (80019) and provide LPA Colvin with statement of understanding regarding requirements for all adults and staff who enter the facility. Due by Plan of Correction date of 11/30/22.
	8 9 10 11 12 13 14	Based on interviews, the Licensee did not comply with the above regulation on at least one date. Interviews support that on 3/31/21, residents were left alone in the facility with a non-staff member named "Mark". No person named "Mark" was associated to facility. This was an immediate safety risk to all residents.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2022

LIC9099 (FAS) - (06/04)

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