360902944-10-10-2023-56-AS-EMAN-CWSPBK-20231020111025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 360902944
Report Date: 10/10/2023
Date Signed: 10/10/2023 12:57:26 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
08/02/2023 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230802093701

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: 147	DATE:	10/10/2023
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Memory Care Director Denise Perez		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff are placing multiple diapers on the residents.
Staff are not providing comfortable accommodations for the residents.
Staff do not have planned activities for the residents.
Staff mishandle the residents medications while in care.
Inland Christian Home Staff do not provide adequate food services for the residents.

INVESTIGATION FINDINGS:

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On 10/10/2023, at 10:09 AM, Licensing Program Analysts (LPAs) Melody Brown and Bianca Wolcott conducted an unannounced visit to the facility to deliver findings for the above allegations. LPAs Brown and Wolcott identified themselves and discussed the purpose of the visit with Memory Care Director Denise Perez.

The investigation was conducted by LPAs Brown and Wolcott. The investigation consisted of file review and interviews with relevant parties. The first allegation indicates Staff are placing multiple diapers on the residents. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with Staff # 1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) all indicated that they never placed multiple diapers on residents, and they all added that they never witnessed an incontinent resident at the facility wearing multiple diapers. Interviews with Resident #4 (R4) and Resident #5 (R5) revealed that they are wearing one (1) diaper. Moreover, residents and staffs’ interviews revealed that staffs’ are checking on residents to check on them if they needed to be change. *** Continuation on 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: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

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-20230802093701

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: 10/10/2023

NARRATIVE

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During the facility visit on 10/09/2023, LPAs Melody Brown and Bianca Wolcott observed residents wearing one (1) diaper.

The second allegation indicates Staff are not providing comfortable accommodations for the residents. Interviews with Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) all indicated that they are providing comfortable accommodation for the residents. S2, S3 and S4 reported that they are asking residents on wheelchair every hour to transfer to a recliner chair to be comfortable if they are in the common area watching television (TV) and there is no incident that residents are just left in their wheelchair. S2, S3 and S4 added that there are residents that sometimes refused to be transferred to a chair and recliner, but they still continue asking them every hour. Resident #4 and Resident #5 interviews confirmed that staffs are transferring them to a chair or recliner chair to be comfortable when they are watching TV. During the visit on 10/09/2023, LPAs Brown and Wolcott observed staff transferred residents on wheelchair in a recliner chair for comfort.

The third allegation indicates Staff do not have planned activities for the residents. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with Staff # 1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4), Staff #5 (S5) all indicated that they have planned activities for their residents everyday and there is no day that they do not have activities for their residents. Interviews with Resident #4 (R4) and Resident #5 (R5) revealed that the facility have activities for them everyday. During the facility visit on 10/09/2023, LPAs Brown and Wolcott observed residents attending the scheduled activity for the day at the Activity Room.

The fourth allegation indicates Staff mishandle the residents medications while in care. Interviews with Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) all denied mishandling residents medications while in care. S1, S2, S3, and S4 all reported that they never pre-pour residents medications and there's no incident happened that a staff pre-poured a resident medication. Resident #4 (R4) and Resident #5 (R5) both confirmed that they are receiving their medications on time and there's no incident that staff mishandle their medications.

The fifth allegation indicates Inland Christian Home Staff do not provide adequate food services for the residents. During the investigation, LPAs Brown and Wolcott did not find evidence to corroborate the allegation. ***Continuation in LIC9099C ***

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230802093701

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: 10/10/2023

NARRATIVE

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Interviews with Staff # 1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4) indicated that the facility provide adequate food services for the residents. During the facility visit on 08/04/2023, LPA Brown obtained records of kitchen staffs updated food handlers card and ServSafe Certificate. In addition, LPA Brown observed the facility's Daily Dish Machine Sanitation Log for the month of August 2023. During the facility visit on 10/09/2023, LPAs Brown and Wolcott obtained the facility's Daily Dish Machine Sanitation Log for the month September 2023. Also, LPAs Brown and Wolcott observed the facility kitchen clean and sanitary during the visit on 10/09/2023.

Based on interviews and records review, the allegations Staff are placing multiple diapers on the residents (Allegation #1), Staff are not providing comfortable accommodations for the residents (Allegation #2), Staff do not have planned activities for the residents (Allegation #3), Staff mishandle the residents medications while in care (Allegation #4), Inland Christian Home Staff do not provide adequate food services for the residents (Allegation #5) are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, where this report (LIC9099) was discussed and provided to 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: 10/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023

LIC9099 (FAS) - (06/04)

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