336403573-8-26-2021-18-AS-JESL-C7CQC8-20210930120243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403573
Report Date: 08/26/2021
Date Signed: 08/26/2021 02:17:51 PM

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
08/17/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210817142907

FACILITY NAME:	VILLAGE, THE		FACILITY NUMBER:	336403573
ADMINISTRATOR:	ROB TAKAMI		FACILITY TYPE:	741
ADDRESS:	2200 WEST ACACIA		TELEPHONE:	(951) 766-5116
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY:	452	CENSUS: 289	DATE:	08/26/2021
		UNANNOUNCED	TIME BEGAN:	12:26 PM
MET WITH:	Administrator Michelle Flores		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff do not properly dispose of hazardous waste.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to investigate and deliver findings for the allegation listed above. LPA met with Administrator's Michelle Flores and Jennifer Haas and explained the purpose of the visit as well as the elements of the allegation. Note that the census for Assisted Living was 44 at the time of LPAs visit. The allegation was investigated by the department. The investigation consisted of observation, interviews and record review.

Allegation: Facility staff do not properly dispose of hazardous waste.
LPA conducted interviews and per Administrator items that are defined as hazardous waste are disposed of by being placed in the red bio hazard bag and placed in the red bin located outside in the bio hazard room. Administrator Michelle also stated that the assisted living side does not have too many bio hazardous materials that need to be disposed of. There are times when there is a skin tear, that will require a bandage and if it is soiled then it would be placed inside of the red bio hazard bag. LPA conducted a tour of the physical plant and observed for the medication carts to have the sharps container attached on the side of the cart. The medications that required to be destroyed were logged on the medication destruction record and then placed into a white pharmaceutical waste container, that is located inside of Administrator Michelle's office.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

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-20210817142907

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: VILLAGE, THE	FACILITY NUMBER: 336403573
	VISIT DATE: 08/26/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff interviews were conducted and staff denied that items such as bandages or gauze would be thrown in the regular trash, if there happens to be one then a resident would have placed it in there.

LPA observed the inside of trash bins throughout the facility and in resident bedrooms and did not observe any soiled items such as Band-Aids, or gauze inside of the trash bin. LPA also observed staff emptying various trash bins and nothing out of the ordinary was observed.
Supplemental information LPA reviewed job descriptions for Nursing Assistant, Medication Aide/Caregiver, Security Guard and Food Server. The only one indicated to perform security duties is the appointed Security Guard. LPA conducted interviews and there was not any feedback provided that would suggest or confirm that caregivers or Medication Aides are performing tasks indicated on the security guard job description.

LPA was not able to find any evidence to corroborate the allegation. The department has found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and a copy of this report was provided to Administrator's Michelle Flores and Jennifer Haas.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2