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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425854
Report Date: 07/10/2024
Date Signed: 07/10/2024 10:48:25 AM

Substantiated


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-20240702114314
FACILITY NAME:TEMPLE GARDENSFACILITY NUMBER:
336425854
ADMINISTRATOR:HOBBS, ESTAFACILITY TYPE:
740
ADDRESS:40023 TEMPLE COURTTELEPHONE:
(951) 249-9860
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
07/10/2024
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Licensee, Esta HobbTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Staff are predispensing resident medication 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, LPA conducted interviews, conducted a walk through, and conducted records reviews.

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 medication cups with medications prepoured ahead of time for bedtime. Therefore the allegation is substantiated. Based on LPA’s observations, 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 LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.
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)
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Control Number 18-AS-20240702114314
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 GARDENS
FACILITY NUMBER: 336425854
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/12/2024
Section Cited
CCR
87465(h)(5)
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(h)The following requirements shall apply to medications which are centrally stored: (5)Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. This requirement was not met as evidenced by…
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The licensee agreed to retrain the staff on duty and issue staff warnings to staff who continue to prepour the medications. The licensee agreed to send copies of the medication procedure and staff signatures acknoweldging the training.
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Based on observation the staff are prepouring medication for residents. This poses a potential health safety or personal rights risk.
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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)
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