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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336402685
Report Date: 02/21/2023
Date Signed: 02/21/2023 01:26:47 PM

Substantiated


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
02/15/2023 and conducted by Evaluator Jesse Gardner
COMPLAINT CONTROL NUMBER: 18-AS-20230215124124
FACILITY NAME:UNLIMITED QUEST INC EDGEMONTFACILITY NUMBER:
336402685
ADMINISTRATOR:JONES, REGINAFACILITY TYPE:
775
ADDRESS:23900 ALLESANDRO BLVD STE ATELEPHONE:
(951) 653-0054
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:45CENSUS: 20DATE:
02/21/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Melissa Marcelian, Assistant AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Hoyer lift is in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct an investigation into the above allegation. LPA met with Assistant Administrator Melissa Marcelian. LPA toured the facility, and during the tour found a Hoyer Lift that was torn and staples were used to repair the nylon sling. Due to this, LPA found that the allegation, "Hoyer lift is in disrepair" Substantiated. Staff were able to find another nylon strap and fit into the lift.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
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 5
Control Number 18-AS-20230215124124
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: UNLIMITED QUEST INC EDGEMONT
FACILITY NUMBER: 336402685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2023
Section Cited
CCR
80087(a)
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Buildings and Grounds:
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement was not being met as evidenced by:
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Licensee corrected POC at time of visit by providing a new nylon sling for the Hoyer Lift.
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Based off of LPA observation, and staff interview, LPA found the nylon strap in the Hoyer Lift to be ripped and held up with staples. This presents a potential health and safety risk and/or personal rights risk to clients 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: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5
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
02/15/2023 and conducted by Evaluator Jesse Gardner
COMPLAINT CONTROL NUMBER: 18-AS-20230215124124

FACILITY NAME:UNLIMITED QUEST INC EDGEMONTFACILITY NUMBER:
336402685
ADMINISTRATOR:JONES, REGINAFACILITY TYPE:
775
ADDRESS:23900 ALLESANDRO BLVD STE ATELEPHONE:
(951) 653-0054
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92553
CAPACITY:45CENSUS: 20DATE:
02/21/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Regina Jones, AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff did not treat resident with respect
Staff not providing activities for clients
Staff does not ensure client is changed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct an investigation into the above allegations. LPA met with Assistant Administrator Melissa Marcelian. LPA toured the facility.

It was alleged that Staff 1 (S1) tossed a playing card in the direction of Client 1 (C1) who was sitting at the table on an undetermined date. Through interview with staff and residents, LPA could not determine that the playing card was thrown at C1. Thus this allegation was Unsubstantiated.

It was then alleged that staff do not provide activities for clients. Through observation and interview with staff and clients, LPA found that there are an abundant supply of activities that are provided for the clients. Thus this allegation was Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20230215124124
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: UNLIMITED QUEST INC EDGEMONT
FACILITY NUMBER: 336402685
VISIT DATE: 02/21/2023
NARRATIVE
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It was further alleged that Client 2 (C2) is not changed when experiencing incontinent challenges. Through interviews with staff and C2, LPA found that C2 is verbal and can indicate if they are desirous of changing. Staff do, in fact, ask C2 if they need changing. LPA found that C2 is changed. Thus this allegation was Unsubstantiated.

The allegations identified were 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 where a copy of this report was discussed with and provided along with a copy of the LIC9099-C, and LIC811 (confidential names list).
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20230215124124
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: UNLIMITED QUEST INC EDGEMONT
FACILITY NUMBER: 336402685
VISIT DATE: 02/21/2023
NARRATIVE
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An exit interview was conducted where a copy of this report was discussed with and provided along with a copy of the LIC9099-C, LIC9099-D, and Appeal Rights.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5