331881142-12-14-2023-56-AS-EMAN-CYNNE2-20231219092310

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881142
Report Date: 12/14/2023
Date Signed: 12/14/2023 10:04:52 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
11/06/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231106122200

FACILITY NAME:	TWIN HEARTS SENIOR CARE, LLC		FACILITY NUMBER:	331881142
ADMINISTRATOR:	MANGENTE, KRISTINE A.		FACILITY TYPE:	740
ADDRESS:	995 BOUQUET CIR.		TELEPHONE:	(951) 736-6925
CITY:	CORONA	STATE: CA	ZIP CODE:	92881
CAPACITY:	6	CENSUS: 5	DATE:	12/14/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Mildred Manuel- Caregiver		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not adequately feed a resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to deliver findings for the allegation listed above. LPA stated the purpose of the visit, was granted entry, and met with Caregiver Mildred Manuel. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Staff did not adequately feed a resident while in care:

Interviews with residents and the staff revealed that the residents are fed three (3) meals a day including breakfast, lunch, and dinner. These meals include protein, vegetables, carbohydrates, and fruit. Additionally, the residents have snacks throughout the day in between meals. If the residents are not full with the amount of food provided for a meal, the residents can request more food. Additionally, the residents can request extra snacks at any point during the day. Interviews with the residents revealed the residents have not been denied food. During document review, LPA did not find information to collaborate the allegation. Overall, there was not enough evidence to collaborate the allegation listed above.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

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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Control Number 56-AS-20231106122200

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: TWIN HEARTS SENIOR CARE, LLC	FACILITY NUMBER: 331881142
	VISIT DATE: 12/14/2023

NARRATIVE

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Based on evidence obtained during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided to Caregiver Mildred Manuel, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023

LIC9099 (FAS) - (06/04)

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