336412425-9-6-2024-18-AS-JDHS-D93N4Y-20240913100844

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336412425
Report Date: 09/06/2024
Date Signed: 09/06/2024 09:31:48 AM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2024 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240904090735

FACILITY NAME:	WINTER WOODS COTTAGES		FACILITY NUMBER:	336412425
ADMINISTRATOR:	EUFEMIA CACDAC		FACILITY TYPE:	740
ADDRESS:	845 W. LA CADENA DRIVE		TELEPHONE:	(951) 682-4198
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92501
CAPACITY:	23	CENSUS: 21	DATE:	09/06/2024
		UNANNOUNCED	TIME BEGAN:	09:13 AM
MET WITH:	ADMINISTRATOR, EUFEMIA CACDAC		TIME COMPLETED:	09:31 AM

ALLEGATION(S):

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Staff does not provide resident food options resulting in resident not eating.
Facility does not provide activities for residents.
Facility does not have hot water.

INVESTIGATION FINDINGS:

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On September 06, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility to deliver the finding pertaining to the listed allegations, met with the Administrator, Eufemia Cacdac. LPA Mixson introduced herself and stated the purpose of the visit.

On September 04, 2024, Community Care Licensing received information stating Staff does not provide resident food options resulting in resident not eating, Facility does not provide activities for residents; and Facility does not have hot water. It was reported that resident is refusing to eat and has not eaten since 08/26/2024, because R1 does not like the food options. It was also reported that there is no access to hot water for bathing. Additionally, it was reported that R1 has a lack of opportunity for socialization.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

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-20240904090735

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: WINTER WOODS COTTAGES	FACILITY NUMBER: 336412425
	VISIT DATE: 09/06/2024

NARRATIVE

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Regarding the allegation facility Staff does not provide resident food options resulting in resident not eating, information obtained from staff and resident interviews it was advised that the facility has a full time cook and that the facility provides health foods and meal options and a verity of food types. The information obtained doe does not corroborate the allegation. The review of the records demonstrated that there are healthy food choices and a verity of food types.
Regarding the allegation Facility does not provide activities for residents’ information obtained from staff and resident interviews advised that there are plenty of activities for the residents and a majority of the resident attend the day program. Additional, information advised that there are activities available daily for the residents who do not attend the day program and for socialization. The review of the records revealed that there are residents who attend the day program and that there are activities scheduled for the residents who do not attend the day program the information obtained does not support the allegation.
Regarding the allegation Facility does not have hot water information obtained from staff and resident interviews, LPA’s observations, and the record review demonstrated that there is hot water available at the facility. Information is not sufficient to prove this allegation is accurate.
Based on information obtained from interviews, record reviews, and observations there was not sufficient evidence to demonstrate that the listed allegations did occur. Therefore, the allegations have been deemed as "UNFOUNDED." An allegation finding of Unfounded means the allegation is false without merit and / or could not have happened or is without a reasonable basis.

The Department has investigated the listed allegations and the information obtained has demonstrated the listed allegations did not occur and therefore, has dismissed the allegations.
An exit interview was conducted where a copy of this report was discussed and provided to the Administrator.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2024

LIC9099 (FAS) - (06/04)

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