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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413282
Report Date: 07/10/2024
Date Signed: 07/10/2024 01:32:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/02/2024 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240702104759
FACILITY NAME:TEMPLE COURT SENIOR CAREFACILITY NUMBER:
336413282
ADMINISTRATOR:ESTA HOBBSFACILITY TYPE:
740
ADDRESS:40009 TEMPLE CT.TELEPHONE:
(951) 461-4750
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
07/10/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Staff, Mauhammad AlviTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff are prepping resident pills a week in advance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegation. LPA met with Licensee, Esta Hobbs who was informed of the purpose of the visit. During the visit, Hobbs needed to attend to a private matter and LPA met with Staff, Mauhammad Alvi, LPA conducted interviews and conducted a walk through.

It was alleged that staff prepare medication (1) week in advanced for the facility residents. LPA conducted a walk through and inspection of the resident medications and observed no prepoured medications. LPA conducted (2) staff interviews who confirmed medications are not prepoured for residents. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.
*LPA was offsite from 11:45pm to 12:45pm
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/02/2024 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240702104759

FACILITY NAME:TEMPLE COURT SENIOR CAREFACILITY NUMBER:
336413282
ADMINISTRATOR:ESTA HOBBSFACILITY TYPE:
740
ADDRESS:40009 TEMPLE CT.TELEPHONE:
(951) 461-4750
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 5DATE:
07/10/2024
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Staff, Mauhammad AlviTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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9
Staff are providing care and supervision to residents wthout a fingerprint clearance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Esta Hobbs who was informed of the purpose of the visit. During the visit, Hobbs needed to attend to a private matter and LPA met with Staff, Mauhammad Alvi. LPA conducted interviews and conducted a walk through.

It was alleged that staff working at the facility did not have a fingerprint clearance. It was alleged Staff #1 (S1) worked at the facility without a fingerprint clearance. LPA conducted (4) staff interviews which revealed conflicting information (3) staff revealed that S1 worked at the facility, while (2) staff stated that S1 was hired and trained but did not work at the facility due to problems with their paperwork. LPA requested information for S1 and found S1 does not have a criminal record clearance. LPA additionally reviewed the staff schedule from 5/13/2024 to 5/19/2024 where S1 was placed on the schedule.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20240702104759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: TEMPLE COURT SENIOR CARE
FACILITY NUMBER: 336413282
VISIT DATE: 07/10/2024
NARRATIVE
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Therefore, based on LPA’s observations, interviews conducted, and records reviewed, 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), are being cited on the attached LIC9099 D. Civil penalties apply to citation at a rate of $100 per day per person in violation, totaling $500. An exit interview was conducted, and a copy of this report was provided.

*LPA was offsite from 11:45pm to 12:45pm

SUPERVISOR'S NAME: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240702104759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: TEMPLE COURT SENIOR CARE
FACILITY NUMBER: 336413282
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/11/2024
Section Cited
CCR
87411(g)(1)
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87411 Personnel Requirements - General
(g) Prior to employment or initial presence in the facility, all employees…shall: (1) Obtain a California clearance or a criminal record exemption as required by law…This requirement was not met as evidenced by…
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The staff agreed to provide a self certified statement of hiring protocol and the need to verify background clearance before employees start working.
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Based on interview and record review it was found that S1 had worked at the facility without a fingerprint clearance. This poses an immediate health saftey, or personal rights risk to residents in care.
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This is due by the POC due date.
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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: Tricia DanielsonTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-233-6759
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4