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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409595
Report Date: 02/27/2024
Date Signed: 02/27/2024 03:23:45 PM

Substantiated


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
10/13/2020 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201013170904
FACILITY NAME:SCENIC VIEW HOME CAREFACILITY NUMBER:
336409595
ADMINISTRATOR:MARILYN HOLMESFACILITY TYPE:
740
ADDRESS:7349 LIPPIZAN DRTELEPHONE:
(951) 727-0175
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:0CENSUS: 0DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Facility representative not availableTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident developed pressure injuries while in care.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA) Javier Prieto made attempts to contact the licensee Marilyn Holmes via phone, email, certified mail, and regular mail in an effort to deliver findings of an investigation into the allegation listed above. LPA was unable to make contact with Marilyn Homles and all email and mail correspondence were returned undeliverable. Effective 8/31/2021 the facility was closed, and licensee whereabouts unknown.

Regarding the allegation, Resident developed pressure injuries while in care; The Department investigated the allegation of resident developed pressure injuries while in care. Interviews with facility staff and documentation reviewed reveal that Resident #1 (R1) developed two pressure injuries one stage 3 on the coccyx and an un-stageable wound on the sacrum.

Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
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 4
Control Number 18-AS-20201013170904
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: SCENIC VIEW HOME CARE
FACILITY NUMBER: 336409595
VISIT DATE: 02/27/2024
NARRATIVE
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Interviews with facility staff revealed that the pressure injuries were caused by facility staff not seeking treatment by a medical professional upon learning that R1 had developing wounds. Interviews with facility staff revealed that the staff was applying a non-prescribed medication ointment to treat the wounds and did not contact R1’s doctor. Departments staff’s investigation and interviews revealed the resident was not receiving services for home health care while residing at the facility.

Due to the violation that the department determines resulted in the injury of a person in care, an immediate civil penalty of $500 is being assessed on 02/07/2024.

Based on interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 Chapter 8, is being cited. A copy of this report will be mailed to the licensee’s address on file via certified mail due to closure of the facility.


SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20201013170904
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: SCENIC VIEW HOME CARE
FACILITY NUMBER: 336409595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/07/2024
Section Cited
CCR
87466
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Observations of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional, and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by:
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Facility representative is not available to discuss plan of correction (POC), although facility will be assessed a civil penalties in relation to this substantiated complaint. Notice of substantiated findings, and civil penalty, will be mailed to last know address for the licensee, via regular and certified US mail.
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Based on file review and interviews, the licensee failed to observe and report R1's change in physical health including multiple pressure injuries and/or wounds and failed to obtain necessary medical care. This poses an immediate health & safety risk to residents.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
10/13/2020 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201013170904

FACILITY NAME:SCENIC VIEW HOME CAREFACILITY NUMBER:
336409595
ADMINISTRATOR:MARILYN HOLMESFACILITY TYPE:
740
ADDRESS:7349 LIPPIZAN DRTELEPHONE:
(951) 727-0175
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:0CENSUS: 0DATE:
02/27/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Facility representative not availableTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Resident is malnourished.
Resident was left in a soiled diaper.
Staff did not meet resident's hygiene needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto made attempts to contact the licensee Marilyn Holmes via phone, email, certified mail, and regular mail in an effort to deliver findings of an investigation into the allegation listed above. LPA was unable to make contact with Marilyn Holmes and all email and mail correspondence were returned undeliverable. Effective 8/31/2021 the facility was closed, and licensee whereabouts unknown.

Regarding the allegation “Resident is malnourished, Resident was left in a soiled diaper, and Staff did not meet resident's hygiene needs.” Due to the closure of the facility 08/31/2021, LPA is unable to interview all parties involved. Therefore, Department staff is unable to determine the preponderance of evidence to prove the allegations did or did not occur. Although the allegations 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. A copy of this report will be mailed to the licensee’s address on file via certified mail due to closure of the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4