331881066-3-28-2024-18-AS-TDAN-D8ETU9-20240823150155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881066
Report Date: 03/28/2024
Date Signed: 03/28/2024 01:05:55 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/19/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240319145347

FACILITY NAME:	REM CALIFORNIA, LLC - SKYLAND		FACILITY NUMBER:	331881066
ADMINISTRATOR:	FLORENCE, TAMARA		FACILITY TYPE:	735
ADDRESS:	24795 SKYLAND DR		TELEPHONE:	(951) 601-3444
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	4	CENSUS: 4	DATE:	03/28/2024
		UNANNOUNCED	TIME BEGAN:	08:39 AM
MET WITH:	Brandyn Hamilton - Supervisor		TIME COMPLETED:	01:13 PM

ALLEGATION(S):

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Staff grabbed resident while repositioning
Staff are not properly trained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to initiate the investigation regarding the allegation(s) listed above. LPA was granted entry and met with Supervisor Brandyn Hamilton, who was Informed of the purpose of the visit. LPA toured the facility, conducted interviews, and collected pertinent documents regarding the allegation(s) listed above.

Regarding the allegation “Staff grabbed resident while repositioning” it was reported that Staff One (S1) had grabbed Client One (C1) by the arms and neck while repositioning them. Interview with Supervisor Brandyn Hamilton revealed S1 was put on leave while they conducted an investigation regarding what was observed on 03/13/2024 during a staff training. LPA conducted interviews with staff who were present on 03/13/2024 who corroborated the reported allegations of S1 grabbing C1 by the arms and neck to reposition C1 and did not utilize C1’s gait belt to reposition. Therefore, based on interviews the allegation “Staff grabbed resident while repositioning” has been deemed substantiated at this time.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

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-20240319145347

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
	VISIT DATE: 03/28/2024

NARRATIVE

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Regarding the allegation “Staff are not properly trained”, it was reported License Vocational Nurse (LVN) LaTonya Turks was conducting a staff training on 03/13/2024 when Turks noticed C1 needed to be repositioned while sitting on a beanbag chair. Turks informed S1 to reposition C1. S1 grabbed and pulled C1’s arms to reposition. Turks immediately stopped S1 and informed S1 not to reposition C1 that way. S1 then grabbed C1 by the neck to reposition C1 on the chair. Turk instructed S1 to stop what they were doing and informed them to use C1’s gait belt to reposition. Interview with staff revealed S1 has been redirected multiple times on how to properly handle C1 or other clients but S1 does not listen to their instructions. Interviews with staff revealed on 03/13/2024, C1 had fallen on the couch due to S1 not utilizing the gait belt correctly while walking with C1. Two staff members present had to assist C1 getting up from the couch. Interview with Supervisor Hamilton revealed S1 was trained on how to utilize the gait belt for S1 but there is no written documentation of S1’s training on how to use the gait belt. Hamilton stated before S1 can conduct one on one care with C1, S1 will need to be trained on how to use the gait belt properly. The facility will conduct an all staff training on body mechanics, transferring individuals, and gait belts. Therefore based on interviews and record review, the allegation “staff are not properly trained” has been deemed substantiated at this time.

A finding that the complaint is SUBSTANTIATED means the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated means that the allegation(s) is valid. A citation is being issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 3) on the attached 9099D.

An exit interview was conducted, and a copy of this report was given to Hamilton along with the LIC 9099-D, LIC 811, and appeal rights.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240319145347

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: REM CALIFORNIA, LLC - SKYLAND	FACILITY NUMBER: 331881066
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/28/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 04/19/2024 Section Cited CCR 80072(a)(3)	1 2 3 4 5 6 7	Personal Rights (a) Except...each client shall have personal rights.. (3) To be free from corporal or unusual punishment, infliction of pain, humiliation...interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter…This requirement was not being met as evidenced by:	1 2 3 4 5 6 7	Licensee conducted an investigation and suspend S1 due to how C1 was handled. Licensee agrees to conduct in-service training with all staff regarding clients personal rights section 80072 and provide proof of such to LPA by POC date.
	8 9 10 11 12 13 14	Based on interviews, S1 had repositioned C1 by the arms and neck and did not utilize C1's gait belt which poses an immediate personal rights and safety risk to client in care.	8 9 10 11 12 13 14
Type B 04/19/2024 Section Cited CCR 80065(a)	1 2 3 4 5 6 7	80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not being met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to conduct in-service training related to gait belts and transferring and repositioning clients with all staff and provide training material and written documentation of staff training to LPA by POC date.
	8 9 10 11 12 13 14	Licensee did not ensure S1 received training on how to properly handle C1 and utilize the gait belt. Based on interviews and lack of records to review, S1 did not properly receive training related to transferring individuals and utilizing the gait belt.This poses a potential health, safety, and personal rights risk to residents in care.	8 9 10 11 12 13 14

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: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2024

LIC9099 (FAS) - (06/04)

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