336426277-7-29-2024-18-AS-JDHS-D7PPC4-20240731111115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426277
Report Date: 07/29/2024
Date Signed: 07/29/2024 04:12:15 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
12/10/2021 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20211210152136

FACILITY NAME:	BLISSFUL CANYON HOMECARE		FACILITY NUMBER:	336426277
ADMINISTRATOR:	ROSALINDA ORLEANS		FACILITY TYPE:	740
ADDRESS:	1770 CENTURY AVE.		TELEPHONE:	(951) 789-0170
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY:	6	CENSUS: 4	DATE:	07/29/2024
		UNANNOUNCED	TIME BEGAN:	03:20 PM
MET WITH:	Administrator, Linda Orleans		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Licensee accused resident of making several complaints.
Facility not following COVID safety protocols.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Administrator, Linda Orleans and LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review.
On 12/10/2021, Community Care Licensing received a complaint alleging Licensee accused resident of making several complaints, facility not following COVID safety protocols. It was reported that the facility accused Resident #1 (R1) of making several complaints. LPA interviewed Administrator, Linda Orleans regarding the allegations. Administrator stated she never accused R1 of making several complaints to the department. Administrator stated residents have the right to make complaints.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

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-20211210152136

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: BLISSFUL CANYON HOMECARE	FACILITY NUMBER: 336426277
	VISIT DATE: 07/29/2024

NARRATIVE

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LPA was unable to interview R1 due to R1 not living at the facility as of January 1, 2022. LPA was unable to obtain contact to interview R1. The initial visit made by a previous LPA was not able to confirm or deny this allegation with any staff members or residents, during the time frame of complaint in 2021.

In regards to the allegation that the facility did not follow COVID safety protocols, LPA interviewed Administrator who stated that the facility did not have any COVID 19 residents or outbreaks at the facility, because they always took precautious seriously. LPA reviewed the migration and infection control plan and observed adequate PPE equipment. LPA was unable to interview R1 due to R1 relocation and unable to obtain contact. Current residents and staff were not at the facility during the time frame of this initial complaint investigation.

Based on LPA’s observation, interviews conducted, and record review, the allegations that Licensee accused resident of making several complaints, facility not following COVID safety protocols is unsubstantiated due to the inability to interview pertinent parties. A finding of unsubstantiated means the allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was discussed with and provided to the Administrator, Linda Orleans.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2024

LIC9099 (FAS) - (06/04)

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