336409176-9-28-2021-18-AS-EMAN-C89L56-20211029082636

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 09/28/2021
Date Signed: 09/28/2021 04:38:33 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
09/22/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210922112816

FACILITY NAME:	LAKES, THE		FACILITY NUMBER:	336409176
ADMINISTRATOR:	TERRY RECORDS		FACILITY TYPE:	740
ADDRESS:	5801 SUN LAKES BLVD		TELEPHONE:	(951) 845-2220
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	237	CENSUS: 94	DATE:	09/28/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Terry Records and Glendalou Deleos		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Medication is inappropriately managed
Staff handle residents roughly
Staff make inappropriate comments to residents
Staff are not meeting residents hygiene needs
Staff do not clean residents' rooms
Facility has roaches

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a complaint investigation. LPA Brown was greeted and granted entrance by a staff at the Reception area. LPA Brown identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Terry Records and Director of Nursing Glendalou Deleos.

The investigation consisted of file review and interviews with relevant parties. The first allegation indicates medication is inappropriately managed. Staffs 1-9 and Residents 1-9 were interviewed and denied that medications were inappropriately managed. Staff 3-5 (S3 -S5) denied medications being inappropriately managed. LPA Brown did not observe any sign of inappropriately managed medication per review of medication records. The second allegation indicates that the staff handle residents roughly. Residents 1-9 (R1 -R9) and Staffs 1-9 (S1-S9) were interviewed and all of them denied that staff are rough to the residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

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-20210922112816

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: LAKES, THE	FACILITY NUMBER: 336409176
	VISIT DATE: 09/28/2021

NARRATIVE

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The third allegation indicates Staff make inappropriate comments to residents. Interviewed with staffs and residents indicated that no staff makes inappropriate comments to residents. The fourth allegation indicates that staff are not meeting residents’ hygiene needs. Interviews with residents and staff indicated that residents’ hygiene needs are being met. LPA Brown did not observe any resident needing hygiene care. The fifth allegation indicated staff not cleaning residents’ room. Interviewed with residents and staff indicated that staff cleans residents’ room every day. LPA Brown observed that all residents’ room are clean. The sixth allegation indicates facility has roaches. Interviewed with residents and staff indicated that facility has no roaches. LPA Brown observed no roaches on residents’ rooms.

Based on interviews with staff, residents, and records review, LPA Brown did not find evidence to corroborate the allegations. Based on interviews and observations, and although the above allegations may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED at this time.

No deficiencies were cited during this visit. Administrator Records had to leave the facility early and an exit interview was conducted where this report was discussed and provided to Ms. Deleos.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2021

LIC9099 (FAS) - (06/04)

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