336426464-6-12-2020-18-AS-JESL-BR3VXS-20200630165000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426464
Report Date: 06/10/2020
Date Signed: 06/12/2020 11:38:50 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/03/2020 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200103141625

FACILITY NAME:	RENAISSANCE VILLAGE RANCHO BELAGO		FACILITY NUMBER:	336426464
ADMINISTRATOR:	JUDITH PIERFAX		FACILITY TYPE:	740
ADDRESS:	27900 BRODIAEA AVE.		TELEPHONE:	(800) 870-8066
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	125	CENSUS: 62	DATE:	06/10/2020
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	LaTonya Davis - Executive Director/Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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*Facility staff does not follow a menu for residents

*Facility does not provide nutritious meals

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Crystal Colvin contacted the facility via telephone to deliver findings of the above complaint via telephone due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the allegation(s) with Executive Director/Administrator LaTonya Davis. Below is a summary of the findings of the investigation:

Regarding allegation "Facility staff does not follow a menu for residents": LPA Colvin interviewed facility staff, residents, the facility's Dietary Consultant, and reviewed the facility's copies of menus for three weeks in December 2019, as well as all four Quarterly Reports from the facility’s Dietary Consultant. LPA Colvin observed that the facility has a menu prepared for each week, which is posted and distributed to the residents. While interviews did reveal that the facility sometimes deviates from the menu by sometimes changing out a side dish or switching the lunch menu and dinner menu for the day, Title 22 Regulations do not prohibit the facility from making occasional changes to the menu, if needed. Based on LPA Colvin's interviews and record review, the above allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

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-20200103141625

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: RENAISSANCE VILLAGE RANCHO BELAGO	FACILITY NUMBER: 336426464
	VISIT DATE: 06/10/2020

NARRATIVE

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Regarding allegation "Facility does not provide nutritious meals": LPA Colvin interviewed kitchen staff, the facility's Dietary Consultant, and reviewed three weeks of the facility's menus from December 2019 and all four Quarterly Reports from the Dietary Consultant from the year 2019. LPA Colvin observed that the facility maintained high marks overall for the reports from the Dietary Consultant, and that there were no concerns in these reports regarding the quality or nutritional value of the meals served. LPA Colvin additionally observed during her visit to the facility for this complaint investigation on 1/10/20 that the facility's kitchen is outfitted with a large white board which clearly marks all residents and their dietary restrictions, both through color-coding and an overall list of residents with their corresponding nutritional needs. These items are additionally reviewed each quarter by the facility's Dietary Consultant and the facility has consistently received perfect marks in these areas (pertinent items included "Menu Correctly Followed", "Correct Portion Sizes Per Menu", "Diet History for Each Client" & "Special Diet Board in Use") in the year of 2019 that was reviewed by LPA Colvin. Based on LPA Colvin's interviews, observations, and record review, the above allegation is UNSUBSTANTIATED.

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 Executive Director/Administrator LaTonya Davis via telephone and a copy of this report was provided to LaTonya via email. Report with facility representative signature was obtained.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 06/10/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2020

LIC9099 (FAS) - (06/04)

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