336409054-4-28-2021-18-AS-KCLS-C2ZM85-20210514092231

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409054
Report Date: 04/28/2021
Date Signed: 04/28/2021 12:05:35 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
04/07/2021 and conducted by Evaluator Deborah Mullen

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210407153940

FACILITY NAME:	DIAMOND RCFE OF MURRIETA		FACILITY NUMBER:	336409054
ADMINISTRATOR:	IARISH MARTINEZ		FACILITY TYPE:	740
ADDRESS:	26973 HOLLYGROVE CT		TELEPHONE:	(951) 304-2162
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92563
CAPACITY:	6	CENSUS: 6	DATE:	04/28/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Agnes Martinez, Licensee		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Resident is not receiving medication as prescribed
Facility staff are over medicating resident
Facility staff do not allow resident to have private visitations
Facility staff did not notice a change in the resident's condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced visit to investigate the above allegations. LPA met with Agnes Martinez, Licensee. The investigation consisted of interviews with Licensee, staff and other witnesses and a review of R1's facility file. LPA observed resident at the facility but was unable to interview resident due to cognitive abilities.

Allegation #1 - Resident is not receiving medication as prescribed. LPA reviewed R1's Medication Administration Record (MAR) log and no discrepancies were observed. Per the Licensee resident is administered medication as prescribed. LPA observations and staff interviews did not provide evidence to corroborate the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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-20210407153940

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: DIAMOND RCFE OF MURRIETA	FACILITY NUMBER: 336409054
	VISIT DATE: 04/28/2021

NARRATIVE

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Allegation #2 - Facility staff is over medicating resident. LPA reviewed R1's MAR logs and medication packs and no discrepancies were observed. Staff, hospice nurse and other witnesses denied seeing or knowledge of R1 being over medication. LPA observations of R1 during the inspection were that R1 has limited verbal response but did not appear to be over medicated.

Allegation #3 - Facility staff do not allow resident to have private visitations. Staff stated R1 is unable to hold the telephone, therefore staff must remain with R1 and assist him/her during the telephone call. Additional witness interviews denied R1 not being given privacy during visits.

Allegation # 4 - Facility staff did not notice a change in the resident's condition. Staff and R1's hospice nurse denied seeing a change in condition of R1. In addition, R1's son stated he visits daily and has not observed a change in condition.

Based on interviews, observations of R1 and a review of R1's records, the allegations are unsubstantiated. 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, therefore the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to Agnes Martinez, Licensee.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

LIC9099 (FAS) - (06/04)

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