331880616-6-29-2021-18-AS-KCLS-C4NTA7-20210706143302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880616
Report Date: 06/29/2021
Date Signed: 06/29/2021 11:36:48 AM

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
06/23/2021 and conducted by Evaluator Deborah Mullen

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210623125928

FACILITY NAME:	ANNA CARE LLC		FACILITY NUMBER:	331880616
ADMINISTRATOR:	BLANCAFLOR, ANNALISA		FACILITY TYPE:	740
ADDRESS:	26461 RIDGEMOOR RD		TELEPHONE:	(909) 231-5700
CITY:	SUN CITY	STATE: CA	ZIP CODE:	92586
CAPACITY:	6	CENSUS: 6	DATE:	06/29/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Anna Lisa Blancaflor, Licensee		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Resident was placed on hospice without proper diagnosis

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Deborah Mullen and Jesse Gardner conducted an unannounced visit to investigate the above allegation LPAs conducted a health and safety check of the home, reviewed resident 1's (R1) facility file and hospice records and interviewed licensee.

The allegation states residence was placed on hospice without proper diagnosis. According to hospice records, R1 has a life limiting condition which qualifies R1 for hospice services. Hospice records also indicate the patient/family has elected palliative care.

This agency has investigated the complaint alleging that residence was placed on hospice without proper diagnosis. We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. An exit interview was conducted, and a copy of this report was reviewed with and provided to Anna Lisa Blancaflor, Licensee.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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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