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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881308
Report Date: 03/24/2023
Date Signed: 03/24/2023 09:55:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
03/22/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230322135625
FACILITY NAME:A PLACE OF LOVEFACILITY NUMBER:
331881308
ADMINISTRATOR:MOJICA, FLORENCEFACILITY TYPE:
735
ADDRESS:1360 N PALM AVETELEPHONE:
(310) 592-5338
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:6CENSUS: 2DATE:
03/24/2023
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Florence Mojica, AdministratorTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff did not refill resident’s prescriptions timely
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unnanounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA met with Florence Mojica, Administator and explained the purpose of the visit and the elements of the allegation. The investigation consisted of observation, interview and record review.

Regarding the allegation of staff did not refill residents's presciptions timely. Resident #1 (R1) is prescibed Olanzapine, Divalproex and Atorvasting. A review of documentation revealed that R1 has been out of the listed medications since March 19, 2023. R1 had a telehealth appointment on March 17, 2023 where the medication refill was authorized and sent to the wrong pharamcy outside of town. Due to the delay with medication. The Administrator called to check the status of the medications being sent to the pharmacy in town, and that she would come and pick up the medication instead. The Pharmacy Technician stated that the medications were already being mailed and should arrive either in the afternoon or evening today, March 24, 2023.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
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 2
Control Number 18-AS-20230322135625
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: A PLACE OF LOVE
FACILITY NUMBER: 331881308
VISIT DATE: 03/24/2023
NARRATIVE
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Additional information provided was that R1's Psychiatrist will not speak with anyone at the facility but R1, this has caused miscommunication amongst all parties . Additionally, the Administrator and R1s Conservator are taking the necessary steps to get R1 a Psychiatrist in town to assist with a smoother process with R1 and getting their medications as well as continuity of care.

Based on the information provided there is not enough evidence to corroborate the allegation of Staff did not refill resident’s prescriptions timely is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted and a copy of this report and LIC 811 (confidential names list) was provided to Administrator Florence Mojica.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2