331880616-9-15-2021-18-AS-JESL-C7BTPA-20210929145402

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880616
Report Date: 09/15/2021
Date Signed: 09/15/2021 03:45:26 PM

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
01/12/2021 and conducted by Evaluator Javina George

COMPLAINT CONTROL NUMBER: 18-AS-20210112114206

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: 5	DATE:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	02:38 PM
MET WITH:	Caregiver Haydee Tuyay		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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LPA conducted interviews with staff, residents and members apart of R1 treatment team. Staff interviewed denied that R1 witnessing that R1 had in fact been handled in a rough manner. R1 stated during the interview that they were not able to walk unattended, due to previous falls resulting in an injury. R1 stated that “staff treats me great and have been really good to me.” There were two staff, Staff #1(S1) and Staff 2 (S2) that pulled my arm, I think they misunderstood what I said, in regard to not being able to walk without my walker. Then again, I cannot remember, I do not know how I got here and why I cannot go home.”

During an interview with Administrator, whom confirmed that she was aware of the complaint, and stated that part of the reason why the two staff in question no longer work at the facility. However, did not have any evidence to support the accusation occurred as both staff in question denied the allegation. Administrator stated that S1 and S2 were utilized for emergency purposes, due to covid positive cases and the facility needing staffing.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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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Control Number 18-AS-20210112114206

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: ANNA CARE LLC	FACILITY NUMBER: 331880616
	VISIT DATE: 09/15/2021

NARRATIVE

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LPA interviewed S1 and S2 whom both denied handling R1 in a rough manner. The allegation of staff handled resident is a rough manner is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted and a copy of this report was provided to Caregiver Haydee Tuyay.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

LIC9099 (FAS) - (06/04)

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