331881142-1-17-2024-56-AS-EMAN-CZZ24A-20240130160336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881142
Report Date: 01/17/2024
Date Signed: 01/17/2024 01:16:54 PM

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
11/22/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231122112404

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:	01/17/2024
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Care Giver Frederic Manuel		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff do not respond to resident(s) requests for assistance in a timely manner.
Staff do not ensure that resident(s) have a sufficient amount of liquids.
Staff do not assist resident(s) with mobility needs as necessary.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit, was granted entry, and met with care giver Frederic Manuel. The investigation consisted of resident interviews, staff interviews, and document review.

For the allegation, Staff do not respond to resident(s) requests for assistance in a timely manner.

During interviews with staff, all staff informed LPA they assistance residents in a timely manner.

During interview with residents, 2 out of the 5 residents stated they receive assistance in a timely manner. During the investigation, LPA Rico did not find evidence to corroborate the allegation.

For the allegation, Staff do not ensure that resident(s) have a sufficient amount of liquids.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

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 56-AS-20231122112404

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: 01/17/2024

NARRATIVE

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During interview with staff, all staff informed LPA they ensure residents have sufficient of liquids.

During interviews with residents, 2 out of the 5 residents stated they received sufficient amount of liquids. During in the investigation, LPA Rico did not find evidence to corroborate the allegation.

During facility tour, LPA observed sufficient amount of liquids at the facility and 3 out of the 5 residents had water bottles in their bedroom. During the investigation, LPA Rico did not find evidence to corroborate the allegation.

For the allegation, Staff do not assist resident(s) with mobility needs as necessary.

During interviews with staff, all staff stated they assist their residents with mobility needs as necessary and per their request.

During interviews with residents, 2 out of the 5 residents stated staff assistance them with mobility when needed. During investigations, LPA Rico did not find evidence to corroborate the allegation.

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 Frederic Manuel.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 01/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/17/2024

LIC9099 (FAS) - (06/04)

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