331880842-7-7-2021-18-AS-STOS-C4PNVX-20210707104750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880842
Report Date: 06/08/2021
Date Signed: 07/07/2021 10:47:50 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
06/07/2021 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210607084313

FACILITY NAME:	MARY GRACE LOVING CARE		FACILITY NUMBER:	331880842
ADMINISTRATOR:	ABADILLA, MARY GRACE		FACILITY TYPE:	740
ADDRESS:	31-760 AVENIDA DEL PADRE		TELEPHONE:	(760) 992-0824
CITY:	CATHEDRAL CITY	STATE: CA	ZIP CODE:	92234
CAPACITY:	6	CENSUS: 6	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Christian Gerada, Assistant Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to provide copies of resident records to authorized representative.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA identified herself and informed Administrator, Mary Grace Abadilla, and Assistant Administrator, Christian Gerada, of the purpose of the visit.

Regarding the allegation, "Facility failed to provide copies of resident records to authorized representative," it was alleged Resident One's (R1's) authorized representative requested copies of their records which were not promptly provided. The LPA initiated the investigation on this date; the LPA conducted staff interviews, reviewed records, and took copies of pertinent information. According to Assistant Administrator, Gerada, the request for R1's records was received on June 05, 2021. Records review was conducted; a receipt of delivery revealed the letter of request was delivered on June 04, 2021. According to Gerada, contact was made to the resident's authorized representative on June 07, 2021. Per regulation 1569.269(a)(21), the records are to be provided within two (2) business days. Further interviews revealed R1's authorized representative

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 06/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021

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 2

Control Number 18-AS-20210607084313

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: MARY GRACE LOVING CARE	FACILITY NUMBER: 331880842
	VISIT DATE: 06/08/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

would not have been available to receive contact until June 07, 2021. In addition, email records show Gerada previously provided R1's authorized representative with copies of the resident's records on January 25, 2021. Therefore, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

An exit interview was conducted with Abadilla and Gerada, in which this report was reviewed, and a copy provided.

NOTE: This report was amended to reflect the correct facility visit date of 06/09/2021.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
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

LIC9099 (FAS) - (06/04)

Page: 2 of 2