336405884-11-23-2022-18-AS-EMAN-CLN2LF-20221129162926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336405884
Report Date: 11/23/2022
Date Signed: 11/23/2022 10:58:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201124160612

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - A1		FACILITY NUMBER:	336405884
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14265 NASON STREET		TELEPHONE:	(951) 601-9100
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	22	CENSUS: 17	DATE:	11/23/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Tasha Graham		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff handled resident in a rough manner resulting in bruising

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility to investigate and deliver findings to the above allegation. LPA Guerrero identified herself to Facility Manager Tasha Graham, and Treatment Nurse Hazzel Lamontague, who was also informed of the purpose of the visit. The investigation consisted of direct observations, records review, and interviews with staff and residents. Regarding the allegation, LPA Guerrero was unable to interview Resident #1 (R1) due to R1 passing away in December 13,2020. LPA Guerrero interviewed Resident #2 (R2) Resident #3 (R3) and Resident#4 (R4) who all denied that staff members are handling residents in a rough manner. LPA Guerrero interviewed Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) who all denied mishandling any resident and denied having knowledge of other staff members mishandling any resident.

Due to lack of evidence to corroborate the allegation, the allegation is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

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-20201124160612

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: INTEGRATED CARE COMMUNITIES - A1	FACILITY NUMBER: 336405884
	VISIT DATE: 11/23/2022

NARRATIVE

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Based on evidence obtained during today’s visit, LPA Guerrero has determined that the above allegation is UNSUBSTANTIATED; meaning 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 this report (LIC 9099) was discussed, and a copy was provided to Facility Manager Tasha Graham at the conclusion of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 11/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/23/2022

LIC9099 (FAS) - (06/04)

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