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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336405885
Report Date: 07/18/2024
Date Signed: 07/18/2024 02:37:55 PM


Document Has Been Signed on 07/18/2024 02:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:INTEGRATED CARE COMMUNITIES - B1FACILITY NUMBER:
336405885
ADMINISTRATOR:EMELY C. RODRIGUEZFACILITY TYPE:
740
ADDRESS:14295 NASON STREETTELEPHONE:
(951) 601-9150
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:20CENSUS: 16DATE:
07/18/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Emely Rodriguez, AdministratorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to follow up on a report of alleged abuse and neglect. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit.

The LPA received a report, on 07/18/2024, of alleged verbal abuse by staff toward a resident in care. A report was also received on 07/18/2024 regarding staff members not answering the call system when a resident in care utilizes the pull cord in their bedroom.

During the visit the LPA conducted staff and resident interviews, reviewed, and collected copies of relevant documentation. Three staff interviews reported having no knowledge of any staff members yelling at residents in care. Two staff interviews reported staff did have to speak to Resident One (R1) sternly after the resident was observed to be cussing when yelling at Resident Two (R2) on or around 07/17/2024. Staff interviews reported R1 frequently yells at other residents in care and staff intervene to discontinue the behavior. Four resident interviews were conducted; two residents reported staff have been observed to be yelling at residents while the remaining two residents reported they have never observed staff to yell at residents in care. Regarding the call system, one resident interview reported no occasion in which they have had to use the call system, while a second interview reported staff answer the pull cord within or under ten (10) minutes. Administrator Rodriguez was interviewed and reported no knowledge of the above concerns.

No information was obtained, at the time of visit, to substantiate either allegation.

This report was reviewed with Administrator Rodriguez and a copy was provided.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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