336426464-5-9-2023-18-AS-EMAN-CRWTFM-20230517144142

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426464
Report Date: 05/09/2023
Date Signed: 05/09/2023 12:21:57 PM

Unsubstantiated

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
12/16/2020 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201216151852

FACILITY NAME:	RENAISSANCE VILLAGE RANCHO BELAGO		FACILITY NUMBER:	336426464
ADMINISTRATOR:	EREBHOLO, LATONYA		FACILITY TYPE:	740
ADDRESS:	27900 BRODIAEA AVE.		TELEPHONE:	(800) 870-8066
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	0	CENSUS: 0	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Brian Taube-Executive Director		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Inadequate staffing to meet the needs of the resident's.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to deliver findings for the above complaint allegations. LPA met with Executive Director Brian Taube and explained the reason for the visit. During a visit on 3/14/23, LPA discovered that the facility is under new ownership, changed their name, and has mostly new staffing.

The investigation was initiated in 12/28/2020 which consisted of interviews and file review revealed the following:

For allegation, Inadequate staffing to meet the needs of the residents:

It was alleged that there was not enough staffing in the memory care unit in December of 2020.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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-20201216151852

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: 05/09/2023

NARRATIVE

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During interviews with staff, LPA found two (2) staff that worked at the facility prior to the new ownership and name change of the facility. The two (2) staff both stated that during December of 2020, they felt overworked due to losing staffing during the COVID pandemic. The two (2) staff stated they would often work double shifts to ensure the safety of the residents in care.

During interviews with residents, LPA did not find any residents that had information about the staffing in 2020. The current residents did not have issues with the staffing levels at the facility.

During document review, LPA was unable to review a staffing schedule for the month of December 2020. The new facility does not have access to the old facilities staffing schedules.

Based on the evidence found during the investigation, the allegation listed above is deemed UNSUBSTANTIATED. A finding that the complaint is 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.

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 Executive Director Brian Taube, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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