331800083-2-5-2025-18-AS-JDHS-DE2QE9-20250219110558

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800083
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:47:52 PM

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
02/22/2023 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230222163013

FACILITY NAME:	RENAISSANCE VILLAGE MURRIETA		FACILITY NUMBER:	331800083
ADMINISTRATOR:	BRIAN TAUBE		FACILITY TYPE:	740
ADDRESS:	24271 JACKSON AVENUE		TELEPHONE:	(951) 319-8243
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	166	CENSUS: 94	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Brian Taube, Executive Director		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Due to neglect, staff caused injuries to a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Yolanda Delgado arrived unannounced to the facility and met with Brian Taube in order to deliver the findings for the complaint allegation listed above. During the course of the investigation, staff interviews were conducted along with record reviews.

On February 22, 2023, the Department received a complaint alleging neglect by staff caused injuries to a resident while in care. It was reported that Executive Director (ED), Brian Taube allowed Resident #1 (R1) to sit on their walker chair while the ED pushed R1. It was reported that while ED was pushing R1, to transport R1 from the doctor’s office to the vehicle, the walker hit a crack on the tiled floor. R1 then fell backwards off the walker. R1 complained of pain and the ED contacted 911. R1 was transported to the emergency room.

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Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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 18-AS-20230222163013

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: RENAISSANCE VILLAGE MURRIETA	FACILITY NUMBER: 331800083
	VISIT DATE: 02/05/2025

NARRATIVE

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Medical records were obtained. The review of the Consultation dated 11/12/2022 revealed the chief complaint of R1 using the walker as a wheelchair and fell, with complaint of pain in the occipital region and lumbar area. The Assessment/Plan section of the consultation revealed “Right-sided L1-3 transverse process fractures following a fall out of the wheelchair.”
Staff interviews were conducted. The staff reported the ED was doing transportation on the day of the fall. R1 was taken to a medical appointment. The staff revealed speaking to the ED after the incident. The staff reported the ED informed them when the ED arrived to pick up R1, R1 refused to walk and demanded to be pushed on the walker. The wheel of the walker hit the concrete, the walker tilted and R1 fell onto the concrete. When R1 complained of pain, the ED called 911. The staff further revealed that the walkers are not meant to be sat on and that this is common knowledge at the facility. A second staff interviewed, revealed R1 could walk with a walker, and it had a seat in the middle. This second staff also stated residents and staff were not allowed to use the walker as a wheelchair.

ED admitted that R1 was pushed on their walker and due to the walker hitting an obstruction on the floor, R1 fell off walker and onto the floor. The ED reported R1 sat down on the walker, facing him, and he started to push R1 on the walker. The walker hit something that he assumed was the union between two tiles and R1 fell backwards onto the floor. R1 complained of pain and the ED called 911. The ED described the walker as having a seat in the middle with a back rest. When asked if this was a dual function walker that could also be used as a wheelchair, the ED replied he did not like to use it as a wheelchair. The ED reported he discouraged other residents from using it as a wheelchair. However, he denied ever telling caregivers to monitor or remind residents to not use the walker for that purpose. The ED also denied knowing about any policies that talked about the proper use of the walker. The ED reported that he was now aware that the walkers were not safe to be used as wheelchairs.

Based on review of a website called unicarehealth.com the seat walker cannot be used as a wheelchair. The product is designed to give the resident a rest as they fatigue or become unsteady. The website goes on to explain the structure of the frame and wheels provide only a small wheel base which can tip easily if the walker hits a curb or bump in an uneven pavement or path. When the resident is in a seated position and being pushed backwards, the seat has little support for the resident in this instance causing them to fall in a backwards direction with little or no opportunity to facilitate any action to save themselves from the fall.

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SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20230222163013

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: RENAISSANCE VILLAGE MURRIETA	FACILITY NUMBER: 331800083
	VISIT DATE: 02/05/2025

NARRATIVE

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Based on interviews, record reviews and review of website for proper use of a similar product, the allegation that due to staff neglect, staff caused injuries to resident while in care is Substantiated. This poses a health and safety/personal risk to residents in care and the facility will be cited on Title 22 Regulations. An immediate civil penalty of $500 is being assessed. In accordance with H&S Code Section 1569.49(e), the determination of additional civil penalties for a violation that resulted in a serious injury to the resident, is pending and under review by the Department.

An exit interview was conducted where this report, 9099D, and LIC421 along with appeal information was discussed and provided.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20230222163013

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: RENAISSANCE VILLAGE MURRIETA	FACILITY NUMBER: 331800083
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/05/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/12/2025 Section Cited HSC 1569.49(e)	1 2 3 4 5 6 7	1569.49 Civil penalties; regulations setting forth appeal procedures for deficiencies. (e) For a violation that the department determines resulted in the death of a resident, the civil penalty shall be fifteen thousand dollars ($15,000).	1 2 3 4 5 6 7	Licensee stated staff have been retrained on the proper use of walkers. Licensee will ensure all staff will transport residents safely and properly. Licensee will email copies of training records to LPA by POC due date.
	8 9 10 11 12 13 14	This requirement was not being met as evidenced by: staff neglect, staff caused serious injuries to resident while in care This poses an immediate health and safety risk to residents in care.	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: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-2990
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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