336423397-6-12-2024-56-AS-EMAN-DHXP8K-20250624110540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423397
Report Date: 06/12/2024
Date Signed: 06/12/2024 01:45:24 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
06/07/2024 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240607153815

FACILITY NAME:	HAMNER MANOR		FACILITY NUMBER:	336423397
ADMINISTRATOR:	JAMES VANNOY		FACILITY TYPE:	740
ADDRESS:	7121 MACKINAW CT		TELEPHONE:	(951) 475-5003
CITY:	MIRA LOMA	STATE: CA	ZIP CODE:	91752
CAPACITY:	6	CENSUS: 5	DATE:	06/12/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Administrator Lesly Vannoy		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff failed to seek medical attention for resident in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegation listed above. LPA met with Administrator Lesly Vannoy and staff April Lopez and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, document reviews, and facility tour.

For the allegation, Staff failed to seek medical attention for resident in a timely manner.

During staff interviews, 4 out of the 4 staff informed LPA that R1 receives medical attention in a timely manner. 3 out of the 4 staff informed LPA that R1 has behaviors where she does not sleep and yells throughout the night/day. In addition, 2 out of the 4 staff stated they have reached to R1 Physician for a re-evaluation on medications and staff are now providing 1 on 1 care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

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 56-AS-20240607153815

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HAMNER MANOR	FACILITY NUMBER: 336423397
	VISIT DATE: 06/12/2024

NARRATIVE

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During resident interviews, 2 out of the 5 residents indicated they receive medical attention in a timely manner. During resident interviews, LPA Rico did not find evidence to corroborate the allegation.

During record review, LPA discovered that on 4/23/2024 the facility requested a re-evaluation for R1. On 4/26/2024 facility received new medication order for R1. LPA did not observed bruises on R1 face. R1 refused for photo to be taken by LPA Rico.

Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Administrator Lesley Vannoy along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024

LIC9099 (FAS) - (06/04)

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