331881166-11-22-2024-18-AS-RSTS-DBV2KH-20241211162756

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881166
Report Date: 11/22/2024
Date Signed: 11/22/2024 03:04:54 PM

Unsubstantiated

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
11/18/2024 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20241118110239

FACILITY NAME:	TRANQUILITY VALLEY ASSISTED LIVING		FACILITY NUMBER:	331881166
ADMINISTRATOR:	FUENTES, TERESA		FACILITY TYPE:	740
ADDRESS:	26450 HELENE DRIVE		TELEPHONE:	(951) 807-3397
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	6	CENSUS: 6	DATE:	11/22/2024
		UNANNOUNCED	TIME BEGAN:	08:25 AM
MET WITH:	Soledad Alcantara, Staff		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff engaged in an inappropriate relationship with resident.
Staff financially abused resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with staff, Soledad Alcantara, and was granted access to the home. The LPA spoke with Administrator, Teresa Fuentes, over the phone and informed her of the purpose for the visit.

A report was obtained by the Department alleging Resident One (R1) was in a romantic relationship with Staff One (S1). R1 was interviewed and confirmed they were in a relationship with S1; however, the resident also reported they could have come to the conclusion that the staff member was in a relationship with them on their own. S1 was interviewed and denied the allegation. Additional staff interviews reported R1 and S1 do not have a romantic relationship. Additional resident interviews revealed no knowledge of whether any resident had a romantic relationship with a staff member of the facility. A review of R1's Physician's Report for Residential Care Facilities for the Elderly (RCFE) revealed R1 does have a physical condition which could affect their cognition. No additional records were observed on file that could provide any further information on the matter.

Unsubstantiated

Estimated Days of Completion: 30

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024

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-20241118110239

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: TRANQUILITY VALLEY ASSISTED LIVING	FACILITY NUMBER: 331881166
	VISIT DATE: 11/22/2024

NARRATIVE

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Therefore, due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time. Another report was received by the Department alleging Staff One (S1) and Staff Two (S2) requested Resident One (R1) to withdraw money from their account for personal use. Records review was completed on the facility file, resident file, and staff files. R1's Physician's Report was reviewed and revealed the resident does not have the capacity to manage their own funds. R1's Participant Care Plan Summary revealed money management assistance was to be provided by the board and care facility; however, the report did not identify the facility by name. R1's Admission Agreement revealed assistance with, or management of any resident's monies was not to be provided by the facility. When Administrator Fuentes was interviewed, she confirmed facility staff were not to manage, in any way, resident monies. Records review and an interview with R1 revealed the resident has no responsible party who may oversee the management of R1's finances. According to staff interviews, there are no residents who require assistance with the management of their finances. R1 was interviewed and reported they (R1) asked to be taken to the bank on or around 10/30/2024 in order to find out what their balance was and to take money out for clothing. R1 reported they were transported to the bank by S1. According to R1, S2 verbally directed S1, while on the phone, to have the resident withdraw all of the money from their account so S1 could deposit the money into their own bank account. R1 reported they were willing to give S1 the contents of their bank account. S1 and S2 were interviewed and both staff members denied the allegation. However, S1 reported they were in possession of $1,000 of R1's funds and were safeguarding the funds due to the resident potentially losing the money. In addition, the LPA observed R1's wallet was being safeguarded in a locked drawer at the facility where only staff had access. Additional staff and resident interviews could provide no information relating to the allegation of financial abuse; however, one (1) staff interview reported they were aware S1 was holding onto money belonging to R1. A representative with R1's bank was interviewed and reported no concerning activity was observed when reviewing the resident's transactions. The representative reported they were not a witness to the events that may have taken place involving R1 and S1; however, the representative did state the incident was reported to them by other employees of the bank. The witnesses were not able to be interviewed prior to the conclusion of the investigation. Therefore, due to a lack of information, this allegation is deemed 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 violations occurred. An exit interview was conducted; this report was reviewed with Administrator Fuentes over the phone and a copy was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 11/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024

LIC9099 (FAS) - (06/04)

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