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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 06/16/2021
Date Signed: 06/16/2021 12:40:40 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
01/13/2021 and conducted by Evaluator Pauline Beschorner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210113170257
FACILITY NAME:MONTCLAIR ROYALE SENIOR LIVINGFACILITY NUMBER:
361800147
ADMINISTRATOR:SANTOS, ANNAMARIEFACILITY TYPE:
740
ADDRESS:9685 MONTE VISTA AVETELEPHONE:
(909) 621-3545
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:236CENSUS: 113DATE:
06/16/2021
UNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Araceli SotoTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
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9
Staff are not trained to administer medications.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Pauline Beschorner conducted an unannounced complaint visit in order to deliver findings for the above complaint allegation. LPA met with Care Cordinator Araceli Soto.

The allegation alleges staff are not trained to administer medications. LPA obtained and reviewed employee training records. A review of employee records revealed facility staff are trained in the areas of Hydration, Dementia Care, Tips for ADL's, Sexuality Issues and Promoting Dignity, End of Life Care, APS Mandated Reporter Training, Personal Rights, the aging process, Emergency Preparedeness, and hands on training. Employees also received 9 hours of medication training through Guardian Pharmacy Inc. This training covers medication management, orders and working with pharmacies, documentation, assistance with medication, side effects of medications and errors, and California regulations and medications.

This agency has investigated the complaint alleging staff are not trained to administer medications and have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted, and a copy of this report is being reviewed with and furnished to the facility Care Cordinator Araceli Soto whose signature on this form confirms the above-mentioned documents.

Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2021
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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