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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426771
Report Date: 09/09/2021
Date Signed: 09/09/2021 01:09:56 PM



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
08/31/2021 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210831131011
FACILITY NAME:ACCURO HOMESFACILITY NUMBER:
336426771
ADMINISTRATOR:LESLEY VANNOYFACILITY TYPE:
740
ADDRESS:6764 BLACK FOREST DRIVETELEPHONE:
(951) 479-5260
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 6DATE:
09/09/2021
UNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Lesley VannoyTIME COMPLETED:
01:19 PM
ALLEGATION(S):
1
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9
Staff did not seek medical attention for resident.
Staff did not inform responsible person of resident's fall.
Staff do not follow resident's care plan.
Resident sustained injuries while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate the above allegations. LPA met with caregivers Louis and Joann, administrator Lesley Vannoy arrived shortly. LPA toured the facility, conducted interviews, and reviewed files.

The first two allegations state that staff did not seek medical attention for resident and did not inform responsible party of the resident’s fall. LPA interviewed staff 1 (S1) and staff (S2) who stated that the care provider was notified as soon as Resident 1 (R1) was discovered to have fallen. LPA viewed a text message sent by the caregiver to the responsible party time stamped at 4AM. LPA viewed a transcribed voicemail from the care provider representative and it was time stamped at 2:34AM. The third allegation states that staff do not follow resident’s care plan. During interviews and reviews of documents, LPA discovered that R1’s care plans were followed by staff. The last allegation states that resident sustained injuries while in care. LPA interviews confirmed that R1 injuries resulted from fall while sleeping.
*****CONTINUED ON LIC 9099C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
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 2
Control Number 18-AS-20210831131011
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: ACCURO HOMES
FACILITY NUMBER: 336426771
VISIT DATE: 09/09/2021
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided to Administrator Lesley Vannoy.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2