360902944-4-28-2023-18-AS-NBRN-CRPU9A-20230510152250

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902944
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:02:17 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/28/2022 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220228123141

FACILITY NAME:	INLAND CHRISTIAN HOME, INC		FACILITY NUMBER:	360902944
ADMINISTRATOR:	MARY WOLFF		FACILITY TYPE:	741
ADDRESS:	1950 SOUTH MOUNTAIN AVENUE		TELEPHONE:	(909) 983-0084
CITY:	ONTARIO	STATE: CA	ZIP CODE:	91762
CAPACITY:	297	CENSUS:	DATE:	04/28/2023
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Denise Perez - Memory Care Director		TIME COMPLETED:	02:04 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained a pressure injury while in care
Residents toileting needs are not met
Staff mismanaged residents medication
Staff are not adequately trained
Staff failed to properly supervise residents resulting in residents falling

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent unannounced visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA met with administrator Mary Wolff who was informed of the purpose of today’s visit. Memory Care director Denise Perez arrived during today's visit. The investigation consisted of staff interviews, observations of the memory care unit, and review of relevant records.

Allegation 1: Resident (R1) sustained a pressure injury while in care. LPA was not able to interview Resident 1 (R1). Records received revealed that R1 began receiving hospice services in the middle of February 2022 and was being seen by a shower aid twice a week and a registered nurse twice a week. Staff interviews also revealed that R1 developed stage 1 pressure sores that healed without medical intervention.

Allegation 2: Residents’ toileting needs are not met. Staff interviews revealed that residents are encouraged to toilet every two hours and residents who wear briefs are changed every two hours or sooner as needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

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-20220228123141

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
, CA 92507

FACILITY NAME: INLAND CHRISTIAN HOME, INC	FACILITY NUMBER: 360902944
	VISIT DATE: 04/28/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Interviews with residents revealed that toileting needs are met. During staff interviews, it was discovered that the facility unit does not keep toileting log as all residents require some toileting assistance.

Allegations 3: Staff mismanaged residents’ medication; and Allegation 4: Staff are not adequately trained. LPA observed that the medication room is locked and secured. LPA confirmed that unit staff present during today’s visit hold active certified nursing assistant (CNA) and licensed vocational nursing (LVN) licenses. Staff interviews confirm that medication training includes watching medication management and administration videos and at least 40 hours of hands-on shadowing with a tenured medication technician. LPA observed staff administering medication to a resident during meals.

Allegation 5: Staff failed to properly supervise residents resulting in residents falling. LPA reviewed special incident records and found that R1 had three reported falls in 2019. LPA found that the facility reported three resident falls and two hospitalization not related to Covid-19 between 2021 through 2023. LPA observed multiple residents ambulating, independently and with walking assistive devices, and residents who use wheelchairs.

Based on the information from today's investigation, these five allegations are therefore unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means 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. An exit interview was conducted where this report was discussed and provided to Denise Perez, Memory Care Director.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2