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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425567
Report Date: 03/22/2024
Date Signed: 03/22/2024 03:06:09 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,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201228150324
FACILITY NAME:RISING STAR CARE HOMEFACILITY NUMBER:
336425567
ADMINISTRATOR:JAMES REEDFACILITY TYPE:
740
ADDRESS:30045 AUDELO STREETTELEPHONE:
(951) 609-3300
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:0CENSUS: 0DATE:
03/22/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:James Reed - AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff speaks to resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the new licensed location for the facility (# 331881135) unannounced in order to continue an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator James Reed. Below is a summary of the complaint investigation findings:

Regarding allegation "Staff speaks to resident in an inappropriate manner": LPA Colvin interviewed Administrator James Reed regarding the allegation and James Reed admitted that "disrespect went both ways" in terms of communication between staff and Resident 1 (R1). James Reed denied the specific statements provided to LPA Colvin with the complaint, but acknowledged that staff "snapped back" at R1 due them being tired of R1's attitude and behavior. Therefore, based on admissions from Administrator James Reed, the allegation "Staff speaks to resident in an inappropriate manner" is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: v(951) 217-0236
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
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 5
Control Number 18-AS-20201228150324
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: RISING STAR CARE HOME
FACILITY NUMBER: 336425567
VISIT DATE: 03/22/2024
NARRATIVE
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An exit interview was conducted where a copy of this report, LIC9099D, and appeal rights were provided to Administrator James Reed.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: v(951) 217-0236
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20201228150324
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: RISING STAR CARE HOME
FACILITY NUMBER: 336425567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/23/2024
Section Cited
CCR
87468.1(a)(1)
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Personal Rights of Residents in All Facilities:(a) Residents...shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement was not met as evidenced by:
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Administrator agrees to have all staff re-trained on personal rights of residents. Administrator to provide LPA Colvin with schedule for training all staff by Plan of Correction date of 3/23/24, and proof of trianing for all staff once complete.
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Based on interview, the Licensee did not comply with the above regulation with one resident (R1). LPA Colvin learned from Administrator that staff would speak disrespectfully to R1. This was an immedidate personal rights violation.
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CCR
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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: Joel EsquivelTELEPHONE: v(951) 217-0236
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201228150324

FACILITY NAME:RISING STAR CARE HOMEFACILITY NUMBER:
336425567
ADMINISTRATOR:JAMES REEDFACILITY TYPE:
740
ADDRESS:30045 AUDELO STREETTELEPHONE:
(951) 609-3300
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:0CENSUS: 0DATE:
03/22/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:James Reed - AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Resident's diapering needs are not being met.

Staff denied access to phone.

Staff did not notify the authorized representative of a change in resident's health condition.

Staff did not administer resident's medication
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the new licensed location for the facility (# 331881135) unannounced in order to continue an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator James Reed. Below is a summary of the complaint investigation findings:

Regarding allegation "Resident's diapering needs are not being met.": LPA Colvin reviewed records for R1, previous related interviews conducted by the Department, and interviewed Administrator James Reed. R1's file showed documentation for bowel movements for R1 for up to 4 occurrences a day. Prior staff interviews support this documentation that R1 would have 5-6 bowel movements a day, and that they went through supplies quikly for R1 due to this. There is no evidence to show that R1 was not being changed regularly, such as presence of UTIs. LPA Colvin was unable to interview R1 as R1 has passed away. Therefore, due to lack of evidence to support the claim, the allegation "Resident's diapering needs are not being met." is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: v(951) 217-0236
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
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 5
Control Number 18-AS-20201228150324
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: RISING STAR CARE HOME
FACILITY NUMBER: 336425567
VISIT DATE: 03/22/2024
NARRATIVE
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Regarding allegation "Staff denied access to phone": LPA Colvin interviewed Administrator James Reed as well as reviewed related interviews previously conducted by the Department. Prior interviews with R1's family state that they spoke with R1 every day, though they state they used the facility phone as R1's cell phone was always dead. Administrator James Reed refutes this claim and states that R1's phone was charged and that R1 would use their cell phone. LPA Colvin was unable to interview R1 as they have passed away. Therefore, due to conflicting interviews and lack of evidence to support the claim, the allegation "Staff denied access to phone." is UNSUBSTANTIATED.

Regarding allegation "Staff did not notify the authorized representative of a change in resident's health condition.": LPA Colvin reviewed records for R1, including daily staff notes. LPA Colvin additionally reviewed prior staff interviews conducted by the Department, as well as interviewed Administrator James Reed. There is no evidence in staff notes that staff observed a change of condition to R1 prior to calling 911 on 12/28/20. Administrator James Reed states that he often contacted R1's authorized representative, though it was difficult to get a hold of them at times due to their line of work. Administrator James Reed did not have any retained documentation (such as text messages) of these conversations to provide to LPA Colvin. Therefore, due to lack of evidence to support the claim, the allegation "Staff did not notify the authorized representative of a change in resident's health condition" is UNSUBSTANTIATED.

Regarding allegation "Staff did not administer resident's medication": LPA Colvin reviewed records for Resident One (R1) and interviewed Administrator James Reed regarding the records. LPA Colvin observed Medication Administration Records (MARs) for the medications prescribed to R1, which showed both administrations of the medications, refusals of the medications, and dates that medication was not administered as R1 was not in the facility. LPA Colvin additionally reviewed staff notes which support these administrations and refusals. Therefore, due to lack of evidence to support the claim, the allegation "Staff did not administer resident's medication" is UNSUBTANTIATED.


A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator James Reed, and a copy of this report was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: v(951) 217-0236
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5