331880838-10-6-2023-18-AS-EMAN-CWKQPK-20231013122050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880838
Report Date: 10/06/2023
Date Signed: 10/06/2023 02:51:41 PM

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
11/05/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201105165153

FACILITY NAME:	EMK RESIDENTIAL CARE FOR ELDERLY		FACILITY NUMBER:	331880838
ADMINISTRATOR:	PANALIGAN, MARILOU		FACILITY TYPE:	740
ADDRESS:	7750 BOLERO DRIVE		TELEPHONE:	(909) 561-0301
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	6	CENSUS: 6	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Marilou Panaligan- Licensee/Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruise.
Staff not maintaining residents grooming needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Licensee/Administrator Marilou Panaligan. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Resident sustained unexplained bruise:

Interviews with residents and interviews with the staff revealed that there was no evidence of staff causing bruising to the residents in care. The residents denied being hit, pushed, physically injured, and or bruised by the staff. The staff denied hitting, pushing, causing injuries, and or bruising the residents. Document review of R1’s facility records did not indicate that R1 had bruising. LPA was not able to speak to R1 due to R1 passing away in November of 2020.

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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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-20201105165153

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: EMK RESIDENTIAL CARE FOR ELDERLY	FACILITY NUMBER: 331880838
	VISIT DATE: 10/06/2023

NARRATIVE

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For allegation, Staff not maintaining residents grooming needs:

Interviews with residents and interviews with the staff revealed that there was no evidence of staff neglecting the resident’s grooming needs. The residents denied that the staff is neglecting their grooming needs. The staff denied neglecting the resident’s grooming needs. LPA was not able to speak to R1 due to R1 passing away in November of 2020.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained 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 (LIC9099) was discussed and provided to Licensee/Administrator Marilou Panaligan, 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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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