331880905-2-2-2023-18-AS-JESL-CT96GX-20230628204841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880905
Report Date: 02/02/2023
Date Signed: 02/02/2023 01:18:48 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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/27/2023 and conducted by Evaluator Chinwe Nwogene

COMPLAINT CONTROL NUMBER: 18-AS-20230127161629

FACILITY NAME:	TEMECULA MEMORY CARE		FACILITY NUMBER:	331880905
ADMINISTRATOR:	GEDDIE, JAMES		FACILITY TYPE:	740
ADDRESS:	44320 CAMPANULA WAY		TELEPHONE:	(951) 428-4990
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92592
CAPACITY:	64	CENSUS: 39	DATE:	02/02/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Azizi Baranauskas, Resident Care Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff denied resident access to food.

INVESTIGATION FINDINGS:

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On February 2, 2023, Licensing Program Analyst (LPA) Chinwe Nwogene conducted an unannounced visit to investigate the above allegation. LPA met Resident Care Director, Azizi Baranauskas and explained the purpose of the visit. During the investigation, LPA interviewed staff, interviewed Residents, interviewed Hospice Patient Care Manager, and reviewed resident's file.
Regrading the allegation “Staff denied resident access to food”. It was alleged resident’s Responsible Party requested for a snack from the dinning to take to resident’s room and staff refused. LPA interviewed staff who denied refusing to give resident a snack or food. Staff stated if resident isn’t feeling well, food and snacks will be served to resident in resident’s room free of charge. LPA interviewed residents who denied staff deny residents access to food. Interview with residents revealed residents are served three #3 meals a day and snacks in between meals. Interview with Hospice Patient Care Manager and resident’s file review revealed no evidence of resident being denied access to food.
Based on LPA’s interviews and resident’s file review there is not enough evidence to support the above allegation. Although the allegations 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 reviewed with and provided to Azizi Baranauskas.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Chinwe Nwogene	TELEPHONE: (951) 202-2066
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2023

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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