336407734-12-20-2021-18-AS-JESL-CA7SA2-20211230124137

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407734
Report Date: 12/20/2021
Date Signed: 12/20/2021 02:29:05 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
03/24/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200324130124

FACILITY NAME:	PICO DE LORO		FACILITY NUMBER:	336407734
ADMINISTRATOR:	VIVIEN RILLO/EFREN RILLO		FACILITY TYPE:	740
ADDRESS:	620 NORTH PERRIS BLVD		TELEPHONE:	(951) 943-8081
CITY:	PERRIS	STATE: CA	ZIP CODE:	92571
CAPACITY:	39	CENSUS: 14	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Vivien Rillo - Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not seek medical treatment in a timely manner resulting in death

Residents sustained unexplained bruises

Facility staff does not provide an adequate quality of food

Facility staff left residents in soiled clothing for an extended period of time

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced to follow up on the open complaint with the allegation above. LPA Colvin met with Administrator Vivien Rillo and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility staff did not seek medical treatment in a timely manner resulting in death": This allegation was submitted to Community Care Licensing (CCL) with no resident listed and very little information. At the facility, LPA Colvin reviewed files for multiple residents who passed away in 2019 and 2020, around the time that the complaint was filed. LPA Colvin reviewed these files and observed that many of the residents who passed away during this time period were on Hospice and had serious medical conditions, such as: cancer, Coronary Artery Disease, and Atrial Fibrillation. LPA Colvin additionally reviewed the staff Narrative Charting for these residents as well as any other recent hospital records and Special Incident Reports noting recent declines in condition or trips made to the hosptial for medical emergencies. In the review of these records, LPA Colvin did not observe any unusual circustances regarding these deaths.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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-20200324130124

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: PICO DE LORO	FACILITY NUMBER: 336407734
	VISIT DATE: 12/20/2021

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

Therefore, due to lack of information and inability to identify specific resident of concern, the allegation "Facility staff did not seek medical treatment in a timely manner resulting in death" is UNSUBSTANTIATED.

Regarding the allegation "Residents sustained unexplained bruises": LPA Colvin reviewed files for 11 residents currently living at the facility, who were also living at the facility at the time of the complaint. LPA Colvin reviewed their files for any charting on bruising observed by caregivers, and found that at least four (4) of the 11 residents had incident reports regarding falls, which resulted in calls to 911 and/or bruising. LPA Colvin additionally toured the facility and interviewed residents and did not observe any bruising at this time. Therefore, due to lack of information and evidence, the allegation "Residents sustained unexplained bruises" is UNSUBSTANTIATED.

Regarding allegation "Facility staff does not provide an adequate quality of food": LPA Colvin toured the facility and conducted interviews of residents regarding the allegation. LPA Colvin's interviews did not provide any supporting evidence for the allegation. LPA Colvin additionally reviewed the food supply in the kitchen, including the refrigerator, freezer, and pantry. LPA Colvin observed numerous items from the various food groups which make up a balanced diet. LPA Colvin checked the expiration date on numerous items and observed that every item checked was well within it's expiration date. Therefore, based on interviews and observations, the allegation "Facility staff does not provide an adequate quality of food" is UNSUBSTANTIATED.

Regarding allegation "Facility staff left residents in soiled clothing for an extended period of time": LPA Colvin conducted interviews with residents at the facility as well as reviewed files for current residents who were present at the time of the complaint. LPA Colvin did not observe any evidence in the residents' files (such as presence of a pressure injury or a UTI) which would indicate that the resident was left soiled for an extended period of time. Additionally, LPA Colvin's interviews did not lead to any statements which support the allegation. Therefore, based on interviews and record review, the allegation "Facility staff left residents in soiled clothing for an extended period of time" is UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegations occurred.

A copy of this report was provided to Administrator Vivien Rillo during the exit interview.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2