331880541-7-7-2023-18-AS-JDHS-CTMUQR-20230711154731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880541
Report Date: 07/07/2023
Date Signed: 07/07/2023 03:25:26 PM

Unfounded

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
04/11/2023 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230411151529

FACILITY NAME:	ROLLING GREEN SENIOR CARE		FACILITY NUMBER:	331880541
ADMINISTRATOR:	OKORO, GERTRUDE		FACILITY TYPE:	740
ADDRESS:	42007 THOROUGHBRED LN		TELEPHONE:	(951) 397-3369
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	6	CENSUS: 5	DATE:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	02:33 PM
MET WITH:	LEAD CAREGIVER, LEOCARDIA OGOLLA		TIME COMPLETED:	03:34 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure resident had a comfortable bed.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On July 7, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced and met with the Lead Caregiver. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegation.

On April 13, 2023, LPA Venus Mixson initiated the complaint investigation. During the investigation, LPA Mixson and LPA Stephanie Martinez conducted interviews with the Administrator, Staff Members, and Residents.

On April 11, 2023, Community Care Licensing (CCL), received information which stated staff did not ensure resident had a comfortable bed. It was reported that Resident's bed was unplugged which caused Resident's mattress to be deflated. Interviews revealed that there are no beds at the facility that can deflate. It was reported that one of the resident's bed was unplugged for a period of time, but the Resident was not in the bed during the time. Information obtained from Resident's who were directly affected, indicated that there were no concerns regarding their bedding. No issues or concerns regarding resident's bed was advised.

Based on interviews and observation, this agency has investigated the allegation of staff did not ensure resident had a comfortable bed and we have found that the complaint was unfounded, meaning the allegation was false, could not have happened, or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and a copy of the report, along with the LIC 811, was provided to the Lead Caregiver.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 1