331800237-3-24-2023-18-AS-EMAN-CQ943T-20230324184517

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800237
Report Date: 03/24/2023
Date Signed: 03/24/2023 11:19:56 AM

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
10/20/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201020110311

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: 6	DATE:	03/24/2023
		UNANNOUNCED	TIME BEGAN:	11:01 AM
MET WITH:	Restituto “Resty” Calilung- Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff neglect resulting in resident developing multiple pressure injuries.
Staff did not notice a change in resident's condition.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an announced office visit to deliver findings for the above complaint allegations. LPA met with Administrator Restituto “Resty” Calilung and explained the reason for the visit.

For allegation, Staff neglect resulting in resident developing multiple pressure injuries:

It was alleged that staff denied Resident R1 wound care.

During interviews with staff, LPA discovered that two (2) out of the three (3) staff interviewed did not work at the facility when R1 was living there. Staff (S1) was present during the time R1 lived there. S1 stated that R1 was being treated by a wound care doctor the entire time R1 lived at the facility. S1 stated that an outside wound care company came to the facility to treat R1, but since R1 was already being treated by a different wound care doctor, S1 informed the company their services were not needed.

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: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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-20201020110311

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: 03/24/2023

NARRATIVE

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During interview with R1’s family member (R1FM), R1FM stated that R1 had a history of pressure injuries prior to being admitted to the facility. R1 had a medical condition that caused R1 to spend a large amount of time in their bed. R1FM stated that R1 did not like to be moved around or rotated. R1 would regularly refuse staff to move and rotate R1. R1FM had only good things to say about the care and communication during the time R1 lived at the facility. R1FM did not believe that the facility had fault in R1 developing pressure injuries.

During document review, LPA discovered that R1 was being treated by a wound care doctor for the entirety of their stay at the facility.

For allegation, Staff did not notice a change in resident's condition:

It was alleged that staff did not notice a change in condition for R1’s pressure injuries.

During interviews with staff, LPA discovered that two (2) out of the three (3) staff interviewed did not work at the facility when Resident R1 was living there. Staff (S1) was present during the time R1 lived there. All three (3) staff stated that they pay close attention to their residents needs and report changes in conditions to the resident’s medical providers as well as their reasonable parties. S1 stated that R1 was under constant care and communication with R1’s medical providers. If R1 had a change in condition, it was reported to the necessary parties immediately. S1 stated that R1 had medical providers coming into the facility to closely monitor R1 and any changes noted in between visits with medical providers was reported to the necessary parties.

During interview with R1FM, R1FM stated that the facility would call them, as well as R1’s medical providers, constantly to inform them of changes of conditions for R1. R1FM stated the facility did a great job caring for R1 and the staff paid close attention to changes in condition for R1.

During document review, LPA discovered that outside medical providers were monitoring the change in condition of R1’s pressure injuries. Staff had constant communication with the R1’s medical providers to ensure all parties were up to date on R1’s care

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20201020110311

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: 03/24/2023

NARRATIVE

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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 to Administrator Restituto “Resty” Calilung, 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: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

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