360902944-6-16-2023-56-AS-EMAN-CT6SSC-20230626140742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902944
Report Date: 06/16/2023
Date Signed: 06/16/2023 01:35:05 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
04/12/2023 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230412170744

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: 150	DATE:	06/16/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Mary Wolff and Memory Care Director Denise Perez		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff do not ensure that residents are provided their medication(s) in a timely manner.
Staff do not adequately supervise residents in care.

INVESTIGATION FINDINGS:

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On 06/16/2023 at 09:30 AM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA Brown was greeted and granted entrance by a staff at the reception area and 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.

The first allegation indicates Staff do not ensure that residents are provided their medication(s) in a timely manner. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with staffs and residents indicated that staffs are providing residents medication(s) in a timely manner and no incident happened at the facility that a staff did not ensure that residents were not provided medication(s) in a timely manner. *** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

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 56-AS-20230412170744

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: 06/16/2023

NARRATIVE

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Moreover, staffs interviews revealed that Licensed Vocational Nurses (LVNs) from Skilled Nursing and Assisted Living of the facility are assisting the residents in Memory Care to ensure that residents on insulin were provided their medication in a timely manner. LVNs reported to LPA Brown that no incident happened at the facility that a resident was not able to eat on time due to an incident that a resident was not able to received their medication on time. Also, during the facility visit last 04/18/2023 and 06/16/2023, LPA Brown observed certified nursing assistant (CNA) staffs/Medical Technicians administering medication to a resident during meals. In addition, LPA Brown reviewed Resident #1 (R1), Resident #2 (R2) Resident #3 (R3) and Resident #4 (R4) Medication Administration Records (MARs) and it indicated that their medications were administered in a timely manner.

The second allegation indicates Staff do not adequately supervise residents in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Residents Interviews indicated that staffs are providing appropriate care and supervision to all the residents in care and that all staff are nice and helpful to all the residents. Interviews with staffs revealed that they are all providing adequate care and supervision to their residents at the facility and they are not allowed to use their phone while they are on duty. Moreover, staffs interviews indicated that all staffs are constantly monitoring all residents at the facility to make sure that their residents are adequately supervise and appropriately taken care of and no staff are distracted while on duty. Staffs and residents interviews also revealed that there's no incident happened at the facility that a staff did not adequately supervise a resident in care. Moreover, during the visit last 04/18/2023 and 06/16/2023, LPA Brown observed CNAs/staffs assisting residents in the Activity Room, in the hallway, in their room, in the common area/Day Program area during the tour of the facility with Memory Care Director Denise Perez.

Based on the evidence, the allegation that Staff do not ensure that residents are provided their medication(s) in a timely manner (Allegation #1), Staff do not adequately supervise residents in care (Allegation #2) are 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Administrator Mary Wolff and Memory Care Director Denise Perez.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2023

LIC9099 (FAS) - (06/04)

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