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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 12/23/2021
Date Signed: 12/23/2021 01:33:37 PM

Unsubstantiated


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
10/07/2021 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211007102415
FACILITY NAME:LAKES, THEFACILITY NUMBER:
336409176
ADMINISTRATOR:TERRY RECORDSFACILITY TYPE:
740
ADDRESS:5801 SUN LAKES BLVDTELEPHONE:
(951) 845-2220
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:237CENSUS: 92DATE:
12/23/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Amanda McElwainTIME COMPLETED:
01:45 PM
ALLEGATION(S):
1
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9
Residents are administered expired medication.
Residents are not provided with adequate amounts of food/drink.
Facility does not have appropriate staffing to meet the needs of the residents.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Melody Brown and Bernadette Allen conducted an unannounced visit to the facility to commence a complaint investigation as well as to deliver findings for the allegation(s) listed above. LPAs met with Business Office Director (BOD) Karla Espinoza and explained the purpose of the visit. BOD Espinoza contacted Memory Care Director Amanda McElwain to assist LPAs Brown and Allen on the complaint investigation. LPAs identified themselves and discussed the purpose of the visit and the elements of the allegation(s) with Memory Care Director Amanda McElwain.

The investigation was conducted by LPAs Melody Brown and Bernadette Allen. The investigation consisted of records review and interviews with relevant parties. The first allegation indicates that residents are administered expired medication. During the investigation, LPAs Brown and Allen did not find evidence to corroborate the allegation. Records review and interview with residents and staff indicated that expired medications are not administered to residents.
**** continuation in LIC9099C **** (new LIC9099 generated due to computer error)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
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-20211007102415
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: 12/23/2021
NARRATIVE
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The facility checks expired medications regularly and has computer-based medication records for reference.

The second allegation indicates residents are not provided with adequate amounts of food and drink. During the investigation, LPAs Brown and Allen did not obtain evidence to corroborate the allegation. Interviews with residents, staff and records review indicated adequate amounts of food and drinks are provided to all residents. Breakfast, lunch, dinner, morning snack and afternoon snacks are available to all residents with their choice of drinks. In addition, extra servings of food and drinks are also being provided if requested by residents.

The third allegation indicates that the facility does not have appropriate staffing to meet the needs of the residents. During the investigation, LPAs Brown and Allen did not obtain evidence to corroborate the allegation. Interviews with residents, staff and records review indicated that the facility have appropriate staffing to meet the needs of the residents. Daily shift coverage is being met and if needed, the facility utilizes staffing agency for staff coverage. Interviews with residents also revealed that staff promptly assist them if they asked for help.

Based on the evidence, the allegation that residents are administered expired medication (Allegation #1), residents are not provided with adequate amounts of food and drink (Allegation #2), and the facility does not have appropriate staffing to meet the needs of the residents (Allegation #3) are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegation may have happened 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.

An exit interview was conducted, and a copy of this report (LIC9099) was reviewed with and provided to Memory Care Director Amanda McElwain.

(new LIC9099 generated due to computer error)

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/23/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2