331800108-4-13-2021-18-AS-JESL-C98UNY-20211129144443

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800108
Report Date: 04/13/2021
Date Signed: 04/13/2021 02:05:32 PM

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
02/18/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210218085952

FACILITY NAME:	A B CARING SENIOR LIVING 2		FACILITY NUMBER:	331800108
ADMINISTRATOR:	CARRASCO, REBECCA		FACILITY TYPE:	740
ADDRESS:	470 MEADOWLARK LANE		TELEPHONE:	(951) 435-7592
CITY:	PERRIS	STATE: CA	ZIP CODE:	92570
CAPACITY:	6	CENSUS: 7	DATE:	04/13/2021
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Licensee Rebecca Carrasco		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Uncleared Adult.
Staff slap residents in care.
Staff hit residents in care.
Staff treat residents in care in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM)Joel Esquivel conducted an unannounced visit to deliver findings for the above allegations. LPA met with Licensee/Administrator Rebecca Carrasco. The investigation consisted of interviews, follow up visits and documentation review.

Allegation: Uncleared Adult.
LPA interviewed staff whom admitted that there was an uncleared adult that was both residing as well as assisting the facility with needed tasks such as shopping, assisting with helping residents ambulate and making repairs throughout the facility. Based on the information provided the allegation of uncleared adult at the facility is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
Allegation: Staff slap residents in care.
LPA conducted interviews and information provided stated that there was on altercation between Licensee and Staff #1 (S1), during the altercation resident # 1

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

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

LIC9099 (FAS) - (06/04)

Page: 1 of 5

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
02/18/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210218085952

FACILITY NAME:	A B CARING SENIOR LIVING 2		FACILITY NUMBER:	331800108
ADMINISTRATOR:	CARRASCO, REBECCA		FACILITY TYPE:	740
ADDRESS:	470 MEADOWLARK LANE		TELEPHONE:	(951) 435-7592
CITY:	PERRIS	STATE: CA	ZIP CODE:	92570
CAPACITY:	6	CENSUS: 7	DATE:	04/13/2021
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Licensee Rebecca Carrasco		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff yell at residents in care.
Staff speak inappropriately to residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George and Licensing Program Manager (LPM) Joel Esquivel conducted an unannounced visit to deliver findings for the above allegations. LPA met with Licensee/Administrator Rebecca Carrasco. The investigation consisted of interviews, follow up visits and documentation review.

Allegation: Staff yell at residents in care.
LPA conducted interviews of staff, residents and individuals connected to the facility. The information provided LPA was not able to corroborate the allegation of staff yell at residents in care. Therefore the allegation is UNSUBSTANTIATED . A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation(s) occurred.

Allegation: Staff speak inappropriately to residents in care. LPA conducted interviews of staff, residents and individuals connected to the facility. The information provided, there were not any concerns with how the staff speak to the residents. LPA was unable to

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 18-AS-20210218085952

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: A B CARING SENIOR LIVING 2	FACILITY NUMBER: 331800108
	VISIT DATE: 04/13/2021

NARRATIVE

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corroborate the allegation. Therefore the allegation of Staff speak inappropriately to residents in care is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation(s) occurred.

An exit interview was conducted and a copy of this report 9099C was provided to Licensee/Administrator Rebecca Carrasco.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 18-AS-20210218085952

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: A B CARING SENIOR LIVING 2	FACILITY NUMBER: 331800108
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/13/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/27/2021 Section Cited CCR 87355(e)(1)	1 2 3 4 5 6 7	87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or.. Based interviews, record review and observations the licensee did not ensure that on 1 occasion the licensee did not obtain a criminal record clearance. This poses a potential health and safety risk to persons in care.	1 2 3 4 5 6 7	The licensee will submit the paperwork and provide proof to the department to have Marc associated to the facility by 5pm on the due date indicated.
Type B 04/27/2021 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	80072 Personal Rights a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. The licensee did not ensure that the residents were provided their rights on at least 2 occasions. This poses a potential health and safety risk to persons in care.	1 2 3 4 5 6 7	The licensee will conduct an inservice on respect and personal rights and submit proof to the department by 5pm on the due date indicated.
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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: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 18-AS-20210218085952

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: A B CARING SENIOR LIVING 2	FACILITY NUMBER: 331800108
	VISIT DATE: 04/13/2021

NARRATIVE

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the Licensee/Administrator had pushed R1 in their chest. There was also another incident where Resident #2 (R2) diagnosis had worsened that resulted in the R2 punching the Licensee/Administrator in her jaw, and response she scratched up his neck. The allegation of Staff slap residents in care is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation: Staff hit residents in care.
Feedback provided from interviews stated that there was on occasion where Licensee/Administrator had assisted with pushing R1 out of the way. The licensee/Administrator also scratched up R2 on their neck after being punched in the face. The allegation Staff hit residents in care is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegation: Staff treat residents in care in a rough manner.
Due to the feedback provided of and examples of the Licensee/Administrator pushing R1 and scratching R2s neck the allegation of Staff treat residents in care in a rough manner is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of the report 9099C, 9099D and Appeal rights were provided to Licensee/Administrator Rebecca Carrasco.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021

LIC9099 (FAS) - (06/04)

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