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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881075
Report Date: 11/27/2023
Date Signed: 11/27/2023 04:20:17 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
04/22/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220422161429
FACILITY NAME:INSPIRING LIVES IIFACILITY NUMBER:
331881075
ADMINISTRATOR:LAVENANT, BRITTANYFACILITY TYPE:
735
ADDRESS:5507 INSPIRATION DRTELEPHONE:
(951) 992-9420
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:4CENSUS: 4DATE:
11/27/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brittany Wardle- Lavenant, Licensee TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility not following physician's orders relating to resident dietary needs.
Failure to report an incident involving a resident


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with Licensee Brittany Wardle- Lavenant and explained the purpose of the visit and the elements of the allegation. The allegation(s) were investigated and consisted of observation, interviews and record review.

Regarding the allegation facility not following physician’s orders, a review of the admissions agreement revealed Client #1 (C1) was admitted to the facility on 03/13/2022. A review of medical prescriptions dated 03/24/2022, revealed C1, was given a medically prescribed diet. The medically prescribed diet consisted of: low fat/healthy heart diet, no hot dogs or bologna, eat a variety of fresh fruit and vegetables daily, add high fiber food to diet daily, provide one 8oz glass of milk at breakfast and dinner only in addition to other beverages at mealtime, other fluids throughout the day to avoid dehydration and constipation. It was alleged that in or around August 2022, C1 was fed bologna, and a review of receipts dated August 2022,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
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 8
Control Number 18-AS-20220422161429
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: INSPIRING LIVES II
FACILITY NUMBER: 331881075
VISIT DATE: 11/27/2023
NARRATIVE
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did not reveal purchases of bologna. A review of C1’s food log revealed the facility began tracking C1’s food and beverage intake on 04/21/2022. C1’s food logs dated 05/25/2022 and 06/12/2022, did not note C1 had an 8oz glass of milk during breakfast time as prescribed. However, per interviews with staff, C1 was offered milk but declined it. A review of a Physician’s order dated 03/24/2022 read C1 is to be given one “Gatorade” at lunch. Interviews and food logs revealed C1 was given Body Armour drinks instead of Gatorade, on more than one occasion. Per the licensee the switch was made due to the facility staff having concerns about the vitamins, hydration, and sugar content of the Gatorade versus Body Armour. However, it was revealed facility staff did not consult with the doctor prior to making the switch. The licensee reported they thought C1 only had to have an electrolyte enhancing drink not a specific brand. The allegation is therefore Substantiated.

Regarding the allegation of failure to report an incident involving a resident, interviews with a witness indicated C1 was taken to the emergency room on 04/07/2022 by an approved individual other than facility staff. Interviews further revealed, when C1 returned to the facility on this same day, facility staff were verbally told C1 was taken to the emergency room and that home health services were going to be needed. Facility staff interviews corroborated they were aware of the emergency room visit. Facility staff interviews also revealed home health visited on 04/27/2022, 04/29/2022 and 05/11/2022. The licensee indicated they were unsure if they should report, as they were not the ones that transported C1 to the emergency room. A facility file review was conducted and there was no SIR submitted for C1’s emergency room visit and home health visits. Therefore, this allegation is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report, and appeal rights were reviewed and provided to Licensee, Brittany Brittany Wardle- Lavenant.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 8
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
04/22/2022 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220422161429

FACILITY NAME:INSPIRING LIVES IIFACILITY NUMBER:
331881075
ADMINISTRATOR:LAVENANT, BRITTANYFACILITY TYPE:
735
ADDRESS:5507 INSPIRATION DRTELEPHONE:
(951) 992-9420
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:4CENSUS: 4DATE:
11/27/2023
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Brittany Wardle- Lavenant, Licensee TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility not providing snacks between meals.
Facility not providing adequate food to meet residents needs.
Medications not administered as ordered
Facility retaliated by threatening eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with Licensee Brittany Wardle- Lavenant and explained the purpose of the visit and the elements of the allegation. The allegation(s) were investigated and consisted of observation, interviews and record review.

Regarding allegation of facility not providing snacks between meals, per the review of the facility’s schedule, program plan and menu, 2 snacks are to be provided daily. A snack is to be provided in the AM and the PM. Interviews with facility staff revealed C1 was offered a snack along with the rest of the clients. However, there were times when C1 did not want the snack that was offered and C1 would request the leftovers from the day before. This sometimes included the request for the previous day’s sandwich that C1 was sent to the day program with. Facility records, such as Daily Log Notes, Menus and Substitute Menu were reviewed. They revealed C1 was given snacks while at the facility. In addition, staff interviews revealed C1 was sent to the day program with two (2) snacks in their lunch. C1’s responsible party would
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 18-AS-20220422161429
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: INSPIRING LIVES II
FACILITY NUMBER: 331881075
VISIT DATE: 11/27/2023
NARRATIVE
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also provide fruit snacks for C1, in addition what the facility offered as a snack. This was noted in the Daily Log Notes. Per interview conducted with day program staff, C1 would have snacks provided from the facility. It was further alleged, that on 04/19/2022, C1 requested a snack and drink from facility staff. It was reported that the staff told C1 dinner would be served in an hour and denied C1 the snack. The department attempted to interview C1 but due to C1’s diagnosis, C1 was not able to be interviewed. An Interview with staff regarding this incident, did not corroborate what was alleged and on the contrary denied the allegation. Therefore, this allegation is unsubstantiated at this time.

Regarding the allegation of facility not providing adequate food to meet resident’s needs, a review of the facility menu revealed that a variety of meals were offered/served to all clients in care. Facility staff were interviewed and 7 out of 7, reported that for lunch C1 would be sent with two (2) sandwiches; one peanut butter and jelly and the other turkey; a banana, apple, and orange, two packs of fruits snacks, a bottled water, and a bottle of water with a hydration packet. C1 was also able to have seconds should they wish. Interviews conducted with day program staff revealed C1 did not report they were hungry after eating lunch. The department attempted to interview C1 but due to C1’s diagnosis, C1 was not able to be interviewed. Therefore, this allegation is unsubstantiated at this time.

Regarding the allegation of medications not administered as ordered, a review of the unusual incident/ injury report (SIR) dated 05/11/2022, revealed C1 had missed one dose of a medication. Interviews with facility staff revealed the SIR was submitted for a possible missed medication on 04/19/2022. A review of the SIR revealed C1 was retrieved from the day program by someone other than facility staff. Staff report C1 and companion arrived to retrieve medications for C1, which were to be administered at 1pm and 3pm. Staff report the 1pm medication was not given because the companion reported they had collected the 1pm medication from the day program. Staff interviews revealed they provided the 3pm medication. A review of the Medication Administration Record (MAR) corroborated the 3pm medication for 04/19/2022, was marked with a "1" indicating the medication was provided for "home pass". During the interview with the companion, the companion denied receiving the 3pm medication. It was further alleged C1 was receiving their medication at the wrong time. Facility staff report C1’s medication prescription was changed regarding the time the medication was to be administered. The medication in question was prescribed to be given at bedtime. Per interviews with facility staff, C1’s usual bedtime was 8pm. Per the review of C1’s MAR dated 03/17/2022 - 04/14/2022, C1 was given the noted medication at bedtime. The investigation revealed facility staff received notification on 04/01/2022, from the pharmacist, the medication was to be administered at 9pm specifically.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 18-AS-20220422161429
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: INSPIRING LIVES II
FACILITY NUMBER: 331881075
VISIT DATE: 11/27/2023
NARRATIVE
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Therefore, this allegation is unsubstantiated at this time.

Regarding the allegation facility retaliated by threatening eviction, staff interviews were conducted with both the Administrator and the Licensee, and both denied threatening to evict C1. The department attempted to interview C1 but due to C1’s diagnosis, C1 was not able to be interviewed. Additional facility staff interviews revealed, they did not hear of any threats or possible eviction of C1. Therefore, this allegation is unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted where a copy of this report was discussed and provided to Licensee, Brittany Wardle- Lavenant.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 18-AS-20220422161429
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: INSPIRING LIVES II
FACILITY NUMBER: 331881075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/12/2023
Section Cited
CCR
80076(6)(A)
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80076 Food Services: ( 6) Modified diets prescribed by a client's physician as a medical necessity shall be provided.
(A) The licensee shall obtain and follow instructions from the physician or dietitian on the preparation of the modified diet. This requirement is not met as evidenced by:
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The licensee agrees to conduct an inservice on reviewing and implementing modified diets. Proof of POC is to be provided to the department by 5pm on the due date indicated.
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the licensee failed to followed C1's prescribed diet on 1 out of 1 times. This posed a potential health, safety and personal rights risk.
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Type B
12/12/2023
Section Cited
CCR
80061(b)
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80061 Reporting Requirements
(b) Upon the occurrence, during the operation of the facility, of any of the events specified in ... In addition, a written report containing the information specified in (2) below shall be submitted to the licensing agency within seven days following the occurrence of such event.
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The licensee agrees to comduct an staff inservice on reporting requirements.
Proof of POC is to be provided to the department by 5pm on the due date indicated.
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This requirement is not met as evidenced by: The licensee failed to report an incident 1 out of 1 times. This posed a potential health, safety, or personal rights risk to persons in care.
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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: Jazmond D Harris
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 11/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023
LIC9099 (FAS) - (06/04)
Page: 8 of 8