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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800114
Report Date: 03/22/2023
Date Signed: 03/22/2023 01:22:22 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
08/28/2020 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200828085038
FACILITY NAME:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331800114
ADMINISTRATOR:GREGORY CASEFACILITY TYPE:
740
ADDRESS:27350 NICOLAS RDTELEPHONE:
(951) 308-1988
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:0CENSUS: 0DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Business Office Manager Kelley LaraTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility failed to meet residents bathing needs
Facility failed to assist resident's grooming needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to deliver findings to an investigation into the allegations listed above. LPA met with Business Office Manager Kelley Lara and explained the purpose of the visit. LPA later during the tour of the facility.

It was alleged that staff were not able to keep up with R1’s twice weekly showering, and that they do not have enough staff to provide regular showers, or that residents would only receive "half showers". Interviews with staff revealed that due to the COVID-19 pandemic, the facility had been having shortages as a lot of staff had quit. Upon further interviews with staff, staff acknowledged that residents were not getting bathed accordingly, and that on days that there was a shortness of staff, LPA discovered that some residents were not being bathed at all. Other residents were being bathed via sponge or wiped with a wet towel. Therefore, the facility was not providing adequate needs of the residents. Thus, this allegation was SUBSTANTIATED.

Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
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
Control Number 18-AS-20200828085038
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: VINEYARD RANCH AT TEMECULA
FACILITY NUMBER: 331800114
VISIT DATE: 03/22/2023
NARRATIVE
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It was alleged that R1 had not had a haircut or their nails trimmed since March 2020. R1’s toe-nails were alleged to be extremely long. Interviews with staff revealed the salon had to be closed previously due to the Governor's orders via the COVID-19 pandemic; however, a podiatrist was contacted by the facility and would offer services to residents. Staff interviews revealed that services to trim resident nails were at a higher cost than what basic services were provided by the salon before the salon closed. Due to facility offering services at a higher cost and placing burden on residents, the preponderance of the evidence standard has been met, thus this allegation was Substantiated.

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

Due to facts discovered by LPA, the facility was cited. An exit interview was conducted where a copy of this report was discussed with and provided along with copies of the LIC9099D and appeal rights.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 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
08/28/2020 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200828085038

FACILITY NAME:VINEYARD RANCH AT TEMECULAFACILITY NUMBER:
331800114
ADMINISTRATOR:GREGORY CASEFACILITY TYPE:
740
ADDRESS:27350 NICOLAS RDTELEPHONE:
(951) 308-1988
CITY:TEMECULASTATE: CAZIP CODE:
92591
CAPACITY:0CENSUS: 0DATE:
03/22/2023
UNANNOUNCEDTIME BEGAN:
08:27 AM
MET WITH:Business Office Manager Kelley LaraTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility is not adequately staffed to meet resident needs
Facility failed to renew resident medication
Resident's special dietary needs (no salt) were not met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to deliver findings to an investigation into the allegations listed above. LPA met with Business Office Manager Kelley Lara and explained the purpose of the visit. LPA later during the tour of the facility.

It was alleged due to the pandemic, most staff had quit, and there were not enough staff to provide services to residents in care. Interviews with staff revealed that the facility had 3 caregivers and 1 medical technician for both the am and pm shift. One caregiver on the NOC shift and 1 medical technician for 40 residents per shift. Interviews with residents who lived at the facility during the COVID-19 pandemic indicated that each resident has a push pendant, and that staff were responsive to requests for services. Interviews with residents revealed that during COVID-19, staffing numbers were sufficient as they indicated that their needs were being met. This allegation was therefore Unsubstantiated, as a result, the Department was unable to dismiss the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20200828085038
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: VINEYARD RANCH AT TEMECULA
FACILITY NUMBER: 331800114
VISIT DATE: 03/22/2023
NARRATIVE
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It was alleged that R1’s medication had not been refilled for three weeks. Through interviews with staff, LPA discovered that the doctor’s office wanted R1’s blood drawn due to the type of medication that R1 had been on. Staff advised that the doctor’s office would not refill the medication until the blood draw was done. Due to the COVID-19 pandemic, they were having difficulty getting the blood draw completed. Licensee provided a lab and made available that would be present inside the facility that could conduct the draw; however, R1’s doctor’s office refused. Staff were continuing to work on alternatives with the doctor’s office. Interviews with residents revealed that medications were being ordered and delivered, and there was not a general complaint of residents not getting their medications. Due to lack of evidence, and conflicting accounts, this allegation was Unsubstantiated; therefore, the Department was unable to dismiss the allegation.

It was then alleged that R1 was supposed to be on a no salt diet, but the facility does not abide by it. R1 allegedly gets the same food as everyone else. Interviews with staff revealed that the facility provides a low salt and no salt diet. Interviews with residents revealed that the facility provides a variety of options including low salt/no salt diets. Additionally, residents reported that even if an item is not on the menu, the facility will provide the item. The menu is really for guidance, and there are many options available for residents to choose from. Thus, this allegation was Unsubstantiated.

A finding of UNSUBSTANTIATED means that 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 where a copy of this report was discussed with and provided.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20200828085038
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: VINEYARD RANCH AT TEMECULA
FACILITY NUMBER: 331800114
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/29/2023
Section Cited
CCR
87468.1(a)(2)
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Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This was not being met as evidenced by:
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Licensee agrees to conduct in-service training to staff members providing care to residents and provide proof of training by POC date.
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Based on staff interviews, LPA discovered residents were not receiving showers/baths due to staffing shortages. This is a potential personal rights risk to residents in care.
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Type B
03/29/2023
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This was not being met as evidenced by:
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Licensee agrees to conduct in-service training including Administrator regarding resident rights and submit to LPA by POC date.
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Based on staff interviews, LPA discovered that during the COVID-19 pandemic, resident's regular salon was closed and the facility provided alternative services at a higher cost to residents. This is a potential personal rights risk to residents in care.
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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: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5