331880815-2-22-2023-18-AS-EMAN-CPQP6U-20230308100255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880815
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:43:05 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2022 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220106082752

FACILITY NAME:	A TENDER TOUCH SENIOR LIVING LLC		FACILITY NUMBER:	331880815
ADMINISTRATOR:	MOJICA, FLORENCE A		FACILITY TYPE:	740
ADDRESS:	1651 ROSE AVENUE		TELEPHONE:	(310) 532-5338
CITY:	BEAUMONT	STATE: CA	ZIP CODE:	92223
CAPACITY:	6	CENSUS: 3	DATE:	02/22/2023
		ANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Licensee/Administrator Florence Mojica		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Resident sustained unexplained burns while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Florence Mojica at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 02/22/2023 at 12:20 PM to deliver the findings of the above allegation. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentations.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that due to neglect/lack of supervision, Resident sustained unexplained burns while in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Records review and interviews with staffs and residents indicated that staffs regularly check and monitors all residents at least every two (2) hours or more if needed at the facility to ensure that all residents were provided care and supervision and no incident at the facility happened where a resident sustained unexplained burns while in care. *** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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-20220106082752

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
, CA 92507

FACILITY NAME: A TENDER TOUCH SENIOR LIVING LLC	FACILITY NUMBER: 331880815
	VISIT DATE: 02/22/2023

NARRATIVE

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In addition, staff interviews revealed that during the incident last 01/04/2022, R1 accidentally spilled hot tea on R1’s thigh at the facility and staff immediately helped and assessed R1, provided first aid to R1 and reported the incident to R1’s home health nurse. Residents interviews indicated no incident happened at the facility where a resident sustained unexplained burns while in care. Home Health Nurse reported to LPA Brown that R1 had no unexplained burns during a skin with R1 and no incident happened at the facility where R1 had unexplained burns due to staff neglect and lack of supervision. LPA Brown reviewed R1’s facility documents, home health care notes, hospital records, skilled nursing facility records and LPA Brown did not find evidence that R1 had unexplained burns due to staff neglect or staff lack of supervision.

Based on the evidence, the allegation that Resident sustained unexplained burns while in care 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 where this report, LIC9099 was discussed and provided to Licensee/Administrator Florence Mojica.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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