331881006-5-12-2021-18-AS-KCLS-C34U83-20210517152048

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881006
Report Date: 05/12/2021
Date Signed: 05/12/2021 10:37:59 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
03/25/2021 and conducted by Evaluator Deborah Mullen

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210325105617

FACILITY NAME:	CONCORD ESTATES ASSISTED LIVING		FACILITY NUMBER:	331881006
ADMINISTRATOR:	RAMIREZ, HEATHER		FACILITY TYPE:	740
ADDRESS:	31565 FLINTRIDGE WAY		TELEPHONE:	(619) 251-8508
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 4	DATE:	05/12/2021
		UNANNOUNCED	TIME BEGAN:	10:23 AM
MET WITH:	Heather Ramirez, Licensee		TIME COMPLETED:	10:24 AM

ALLEGATION(S):

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9

Resident was denied visitor

INVESTIGATION FINDINGS:

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Licensing Program Analyst Deborah Mullen contacted Heather Ramirez, License, to deliver the findings of the above allegation. A tele-visit was conducted due to Covid 19 restrictions. The investigation included interviews with licensee and other witnesses.
The allegation states resident 1 (R1) was denied visitors. Interview with licensee revealed that visitors had come to see R1 on 3/24/21, approximately 4 hours after being moved into the home. Licensee stated the visitors were not allowed inside the facility as they were highly agitated and aggressive. Licensee stated she feared for the safety of the other residents as well as herself. Licensee also indicated that R1’s responsible party asked her to only allow their son to visit at this time.
Therefore, based upon the investigation, the allegation is unsubstantiated. 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, therefore the allegations are unsubstantiated at this time. An exit interview was conducted whereby this report was reviewed with Ms. Ramirez. A copy of the report was emailed for her review and signature.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2021

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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