336407346-9-29-2023-56-AS-EMAN-CWGS96-20231010134014

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407346
Report Date: 09/29/2023
Date Signed: 09/29/2023 02:08:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/01/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230801105127

FACILITY NAME:	WILDOMAR SENIOR ASSISTED LIVING		FACILITY NUMBER:	336407346
ADMINISTRATOR:	BROOKE THRALLS		FACILITY TYPE:	740
ADDRESS:	32365 SOUTH PASADENA ST.		TELEPHONE:	(951) 678-1555
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	152	CENSUS: 92	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Cristina Miller- Administrator		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Staff abused resident in care causing bruising.
Staff does not ensure resident is turned resulting in pressure injuries.
Staff yells at residents in care.
Staff handles resident in a rough manner.
Staff does not treat residents with dignity or respect.
Facility does not have adequate staffing to meet resident's needs.
Staff is leaving the residents unattended during work hours for personal reasons.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Administrator Cristina Miller. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Staff abused resident in care causing bruising:

Interviews with residents and interviews with the staff revealed that there was no evidence of staff causing bruising to the residents in care. The residents denied that they have never been hit, pushed, or physically injured or bruised by the staff. The staff denied hitting, pushing, or causing injuries and or bruising to the residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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 56-AS-20230801105127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING	FACILITY NUMBER: 336407346
	VISIT DATE: 09/29/2023

NARRATIVE

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For allegation, Staff does not ensure resident is turned resulting in pressure injuries:

Interviews with the staff and document review revealed that the facility has one (1) resident (R7) with a pressure injury. Interviews with staff revealed that R7 is turned and repositioned every two (2) hours and is under the care of a hospice agency. A document review of the hospice agencies notes dated 7/26/2023 revealed that R7’s pressure injury is under the care of hospice and no staff neglect was noted.

For allegation, Staff yells at residents in care:

Interviews with the staff and the residents revealed that the staff do not yell at the residents. The residents stated that the staff does not yell at them. The staff denied yelling at the residents. The staff stated that they speak to the residents in a kind and respectful manner.

For allegation, Staff handles resident in a rough manner:

Interviews with the residents and the staff revealed that the residents are not handled in a rough manner. The residents stated that the staff do not handle them in a rough manner. The staff denied handling the residents in a rough manner. The staff stated that they are gentle when handling the residents.

For allegation, Staff does not treat residents with dignity or respect:

Interviews with the residents and the staff revealed that the residents are treated with dignity and respect. The residents stated that they are treated well, and they are not yelled at. The staff denied yelling at the residents and stated they treat the residents in a kind and respectful manner.

For allegation, Facility does not have adequate staffing to meet resident's needs:

Interviews with the residents and the staff revealed that there is adequate staffing to meet the residents’ needs. A document review of the facilities staff schedule and staff roster (LIC500) revealed that there is adequate staffing to meet the residents’ needs.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230801105127

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WILDOMAR SENIOR ASSISTED LIVING	FACILITY NUMBER: 336407346
	VISIT DATE: 09/29/2023

NARRATIVE

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For allegation, Staff is leaving the residents unattended during work hours for personal reasons:

Interviews with the staff revealed that the residents are not left unattended during work hours. If a staff member must leave during work hours for a personal reason, management is notified so appropriate staff coverage is made available.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the seven (7) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations 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 (LIC9099) was discussed and provided to Administrator Cristina Miller, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

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