336409176-3-16-2023-18-AS-EMAN-CQ6NET-20230322102426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336409176
Report Date: 03/16/2023
Date Signed: 03/16/2023 01:43:58 PM

Unfounded

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210622121539

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: 99	DATE:	03/16/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Memory Care Director Amanda McElwain		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident is being bullied while in care.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Melody Brown arrived at the facility 03/16/2023 at 09:45 AM unannounced, to follow up on the open complaint with the allegation listed above. LPA Brown met with Memory Care Director Amanda McElwain and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation “Resident is being bullied while in care." LPA Brown reviewed Resident #1 (R1) documents and conducted interviews with relevant parties. Staff interviews indicated that they never bullied a resident or witnessed an incident where a staff bullied a resident. Staff interviews indicated that they all assist and provide care and supervision to all residents and no staff at the facility bullies a resident. Residents’ interviews indicated that staff never bullied them and they did not witnessed an incident at the facility where a staff bullied a resident.
*** Continuation in LIC9099C ***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

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-20210622121539

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
, CA 92507

FACILITY NAME: LAKES, THE	FACILITY NUMBER: 336409176
	VISIT DATE: 03/16/2023

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

Residents’ interviews revealed that all staff are kind and respectful to all the residents and all staff are always ready to help the residents in care and no staff at the facility is a bully to a resident.
In addition, during the facility visit last 03/16/2023, LPA Brown observed staffs providing care and supervision to residents in care in the residents’ room, at the activity area, at the dining area and LPA Brown observed no sign of staff bullying a resident in care

This agency has investigated the complaint alleging "Resident is being bullied while in care.” We have found that the complaint was UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

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

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2