336409176-3-18-2021-18-AS-NBRN-CCTPAY-20220324110929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 03/18/2021
Date Signed: 03/18/2021 02:41:33 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
08/25/2020 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200825143901

FACILITY NAME:	LAKES, THE		FACILITY NUMBER:	336409176
ADMINISTRATOR:	LORI MATSUSHITA		FACILITY TYPE:	740
ADDRESS:	5801 SUN LAKES BLVD		TELEPHONE:	(951) 845-2220
CITY:	BANNING	STATE: CA	ZIP CODE:	92220
CAPACITY:	237	CENSUS: 104	DATE:	03/18/2021
		UNANNOUNCED	TIME BEGAN:	07:45 AM
MET WITH:	Terry Records, Executive Director		TIME COMPLETED:	08:15 AM

ALLEGATION(S):

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-Food is inaccessible to resident's.
-Staff not available to respond to resident's.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Goldenberg is conducting this complaint investigation visit to conclude this agency's investigation into the allegations noted above. LPA Goldenberg is conducting this visit with Executive DIrector Terry Records telephonically.

This investigation included review of the facility record, inquiry into practices in place as related to mitigating COVID 19 spread, interview of one resident and the facility administrator. LPA learned the following information: The snacks were moved behind the front desk to mitigate any risk of cross contamination due to COVID 19. Snacks continue to be available at residents request up until 0900 and arrangements may be made with the kitchen staff to fulfil any dietary needs beyond that time at night. Staff are present during business hours to respond to residents.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2021

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-20200825143901

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: 03/18/2021

NARRATIVE

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If staff is not available at the front desk to answer phones after business hours or when desk staff is needed elsewhere temporarily, the phones are forwarded to the supervisor on duty and an estimated time of arrival would be provided. There is a plan in place for monitoring of incoming visitors signs and symptoms for COVID 19. The facility participated in a Technical Assistance visit with an LPA and a Community Care Licensing Program Clinical Consultant to discuss this plan on 08/07/2020. Based on consideration of all of the elements of the complaint and the information received the alleged violations of food being inaccessible to residents and staff are not available to to respond to residents is unsubstantiated. The allegation may have happened as reported, however, there is not a preponderance of the evidence to prove that the alleged violation has occurred. A copy of this report is being reviewed with and a copy will be furnished to the Executive Director Terry Records via email.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2021

LIC9099 (FAS) - (06/04)

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