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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880967
Report Date: 08/22/2023
Date Signed: 08/22/2023 01:50:12 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
08/07/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230807084041
FACILITY NAME:GARDEN OF EDEN CARE HOMEFACILITY NUMBER:
331880967
ADMINISTRATOR:HOLMES-OTTO, REGINAFACILITY TYPE:
740
ADDRESS:31241 CASERA COURTTELEPHONE:
(951) 388-6204
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 1DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Licensee/ Administrator, Regina Holmes-OttoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not ensure that resident was provided with activities while in care.
Licensee is making false claims regarding services provided by the facility.
Staff confined resident to their bed while in care.
Staff emotionally abused resident while in care.
Staff prohibited resident for using the telephone while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA met with Licensee, Regina Holmes- Otto who was informed of the purpose of the visit. During the investigation, LPA conducted interviews, documented observations, and conducted records reviews.

It was alleged that the resident was not provided with activities at the facility. LPA spoke with Resident #1 (R1) who stated they were not provided with activities at the facility, and stated they stayed in their bed. LPA spoke with licensee who stated they had tv’s for residents to watch and outdoor area for residents to go in, they also showed the LPA the activities they have for the residents to engage in. Therefore, the allegation that the residents were not provided with activities while in care is unsubstantiated as the allegation was unable to be corroborated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
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 6
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
08/07/2023 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230807084041

FACILITY NAME:GARDEN OF EDEN CARE HOMEFACILITY NUMBER:
331880967
ADMINISTRATOR:HOLMES-OTTO, REGINAFACILITY TYPE:
740
ADDRESS:31241 CASERA COURTTELEPHONE:
(951) 388-6204
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 1DATE:
08/22/2023
UNANNOUNCEDTIME BEGAN:
10:29 AM
MET WITH:Licensee/ Administrator, Regina Holmes-OttoTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not ensure that resident was provided their medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA met with Licensee, Regina Holmes- Otto who was informed of the purpose of the visit. During the investigation, LPA conducted interviews, documented observations, and conducted records reviews.

It was alleged that R1 had medication prescribed to them Medication #1 (M1) which was indicated to take thirty minutes before a meal. It was alleged the resident did not receive this medication as indicated and would receive it after meals. LPA reviewed R1’s medication list, MARS sheet, and Centrally stored list for both facilities. MARS sheet for R1 at facility Garden of Eden Care Home indicated M1 had not been documented as given by the staff. The licensee stated they had given medication as prescribed. LPA interviewed the resident who stated they also could not recall if M1 had been given as indicated. Therefore, the allegation that R1 did not take M1 as prescribed is substantiated through corroboration of facility documents.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20230807084041
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: GARDEN OF EDEN CARE HOME
FACILITY NUMBER: 331880967
VISIT DATE: 08/22/2023
NARRATIVE
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Findings that are substantiated mean that the preponderance of the evidence standard has been met. Deficiencies were cited under California Code of Regulations Title 22. The plan of correction was documented and created with the licensee. An exit interview was conducted where this report, 9099-D page and appeal rights were provided to the licensee, Regina Holmes- Otto.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20230807084041
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: GARDEN OF EDEN CARE HOME
FACILITY NUMBER: 331880967
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2023
Section Cited
CCR
87456(a)(4)
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(a)A plan for incidental medical...care shall be developed...(4)The licensee shall assist residents with self-administratered medications as needed.
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The licensee agreed to administer medications to all residents as prescribed and document this for residents on centrally stored list. The POC is to send the LPA
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Based on records and interviews the licensee failed administer medication to R1 and document this on required forms. This poses an immediate health, safety or personal rights risk.
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a written statement of this, and send a completed centrally stored list for the resident by the POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20230807084041
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: GARDEN OF EDEN CARE HOME
FACILITY NUMBER: 331880967
VISIT DATE: 08/22/2023
NARRATIVE
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It was alleged that the facility was making false claims about services provided to the residents. It was alleged the licensee was claiming to be the resident’s nurse and told the resident’s responsible party not to call the hospice nurse and stated “don’t call hospice, I am the one in charge here”. The resident was interviewed who stated that the licensee did claim they used to be a nurse and stated they would take care of them. However, they could not recall if the licensee had denied hospice services. LPA spoke with the licensee who stated she used to be a nurse, but denied acting as a nurse for her residents and denied telling the the resident’s responsible party not to call hospice. Therefore, the allegation was unable to be corroborated and the allegation is unsubstantiated.

It was alleged that staff confined resident to their bed while in care. It was alleged the licensee had stated R1 was “bedridden” and could not get out of bed and therefore kept R1 in bed. Upon review of R1’s LIC602 it was found R1 was not indicated as bedridden but instead stated “non ambulatory”. Licensee was interviewed who also stated R1 was not bedridden. They stated the pre appraisal filled out my R1’s responsible party stated R1 was “In bed most of the time”. LPA reviewed the preappraisal which corroborated the information. The licensee denied confining R1 to their bed. R1 was interviewed who stated they had not been taken out of bed by the licensee. It was also alleged the resident had redness on their rear as a result of not being moved out of bed. LPA interviewed staff at R1’s new facility. The staff stated they observed redness on the resident’s rear upon admission. They stated they did not believe this was due to neglect, as it had “gone away” the next day. The licensee was interviewed who stated the resident had redness from time to time, but would apply cream for the resident where the redness would go away. Therefore the allegation that the resident was confined to their bed was unsubstantiated.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20230807084041
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: GARDEN OF EDEN CARE HOME
FACILITY NUMBER: 331880967
VISIT DATE: 08/22/2023
NARRATIVE
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It was alleged the staff would emotionally abuse the resident. It was alleged that the licensee had told the resident they were “going to die” and would “ignore” the residents requests. LPA interviewed the residents who stated the administrator would ignore the resident when they would ask for something, and be “rude” to them. LPA interviewed the licensee who denied the allegations. LPA interviewed three identified witnesses to the licensee’s behavior. All three witnesses stated the licensee had “rude” demeanor but stated they had not witnessed this directed toward the residents at the facility. The LPA was unable to corroborate the allegation that the staff emotionally abused the resident, therefore it is unsubstantiated.

It was alleged the resident was prohibited from making phone calls while at the facility. LPA interviewed the resident who stated they were told by the licensee that they could not use the phone as it was the “business phone”. LPA interviewed the licensee who stated they would let the resident make phone calls and receive phone calls. LPA spoke with R1's responsible party who stated they had spoken with the resident through the facility phone number. Therefore, the allegation was unable to be corroborated and is unsubstantiated.

Findings that are unsubstantiated mean that although the allegations are valid, the preponderance of the evidence standard has not been met. An exit interview was conducted where this report was reviewed and provided to Licensee, Regina Holmes-Otto.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6