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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426771
Report Date: 06/20/2023
Date Signed: 06/20/2023 12:25:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
10/05/2021 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20211005142519
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:
06/20/2023
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:April LopezTIME COMPLETED:
12:23 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Medication is not being administered as prescribed
Licensee is not safeguarding resident files
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above allegation. LPA met with Facility Administrator April Lopez who was informed of the purpose of my visit and the allegations listed above. The investigation consists of direct observations, records review, and interviews regarding the above allegation.

First Allegation: Medication is not being administered as prescribed.

Regarding the first allegation, Medication is not being administered as prescribed. LPA Guerrero requested to review Resident #1 medication record. LPA conducted a medication record review and observed that Resident #1 medication was being administered based on Resident #1 prescription orders. LPA observed that Mag Zinc and Memantine were the only two medications that was suggested to be taken at a specific time per Physicians orders. Based on documentation LPA observed that medications were being administered as suggested.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola GuerreroTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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-20211005142519
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ACCURO HOMES
FACILITY NUMBER: 336426771
VISIT DATE: 06/20/2023
NARRATIVE
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4
5
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9
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27
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31
32
Second Allegation: Licensee is not safeguarding resident files

Regarding the second allegation, Licensee is not safeguarding resident’s files. LPA Guerrero spoke to facility Administrator and requested to review Resident #1 (R1) file. LPA Guerrero obtained the file pertaining to Resident #1, LPA conducted a file review and observed that the following documentation was in file: (2021 Physicians report, Centrally Stored Medication Record, Admissions Agreement, and Care Plan). Due to a lack of information, the above allegations are deemed UNSUBSTANTIATED at this time.

Unsubstantiated; meaning that 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.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola GuerreroTELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2