331800237-3-10-2023-18-AS-EMAN-CPZMN6-20230317094458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800237
Report Date: 03/10/2023
Date Signed: 03/10/2023 12:53:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
10/05/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201005083827

FACILITY NAME:	GABRIELA CARE HOME INC		FACILITY NUMBER:	331800237
ADMINISTRATOR:	CALILUNG, RESTITUTO		FACILITY TYPE:	740
ADDRESS:	1717 TAMARRON DRIVE		TELEPHONE:	(714) 906-6046
CITY:	CORONA	STATE: CA	ZIP CODE:	92883
CAPACITY:	6	CENSUS: 5	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Restituto “Resty” Calilung- Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff restrained resident.
Resident is not provided with a comfortable bed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to investigate and deliver findings for the above complaint allegations that were initiated on 10/5/2020. LPA met with Administrator Restituto “Resty” Calilung and explained the reason for the visit.

During today’s visit, LPA toured the facility, interviewed staff and residents, and requested and reviewed facility documents.

For allegation, Facility staff restrained resident:

It was alleged that Resident R1 was restrained to their wheelchair using an item not approved by the doctor.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20201005083827

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GABRIELA CARE HOME INC	FACILITY NUMBER: 331800237
	VISIT DATE: 03/10/2023

NARRATIVE

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During interviews with residents, LPA was informed that the residents were not being restrained to their wheelchairs by staff.

During interviews with staff, the staff denied restraining residents to their wheelchairs using an item that was not approved by the doctor. The only time a resident is confined to their wheelchair is by the use of a doctor prescribed seat belt that is used for the resident’s safety.

During document review, LPA found that R1 had doctors order for an approved seat belt to be used on their wheelchair.

For allegation, Resident is not provided with a comfortable bed:

It was alleged that R1 was sleeping on a mattress on their bedroom floor.

During facility tour, LPA discovered that all five (5) residents were laying on a bed with a mattress and a bed frame. LPA did not see any mattresses laying on the resident’s bedroom floors.

During interviews with residents, LPA was informed that the residents were comfortable on their beds and that they have never slept on a mattress on the floor.

During interviews with staff, the staff denied that a resident has ever slept on a mattress on the floor. The residents all sleep on their beds with a mattress and a bed frame.

Based on the evidence found during the investigation, the two (2) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided Administrator Restituto “Resty”, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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