336405886-12-15-2022-18-AS-EMAN-CMDTY9-20221223140821

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336405886
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:21:15 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
06/08/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200608134125

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - B2		FACILITY NUMBER:	336405886
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14315 NASON STREET		TELEPHONE:	(951) 601-9170
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	20	CENSUS: 12	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Emely Rodriguez		TIME COMPLETED:	11:31 AM

ALLEGATION(S):

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Staff neglected resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to the facility to conclude and issue findings for the investigation that was initiated on 06/08/2020. LPA stated the purpose of the visit and was granted entry and met with Administrator Emely Rodriguez.

For allegation, Staff neglected resident:

The investigation included a review of the facility records, facility notes, and interviews with staff. LPA was not able to interview the resident due to the resident passing away.

Based on interviews conducted, and information, and evidence obtained, LPA found that Resident R1 called for help from their bedroom by screaming for staff. Staff S1 responded to R1’s call for help immediately and found R1 laying on the floor. S1 asked R1 if they were in pain and R1 responded that R1 was not in pain.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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-20200608134125

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: INTEGRATED CARE COMMUNITIES - B2	FACILITY NUMBER: 336405886
	VISIT DATE: 12/15/2022

NARRATIVE

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S1 realized that R1 had a bowel movement that needed to be cleaned, so S1 put a medical chuck pad underneath R1. While S1 was cleaning R1, S1 realized R1 was having a hard time breathing and appeared to have clammy skin. At this point, S1 asked S2 to call 911. R1 was on the ground being cleaned by S1 for approximately five (5) to seven (7) minutes prior to 911 being called.

Based on the information found during the investigation, the allegation listed above is deemed UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided Administrator Emely Rodriguez, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

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