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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800210
Report Date: 04/05/2023
Date Signed: 04/05/2023 11:21:07 AM

Substantiated


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
04/04/2022 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220404153243
FACILITY NAME:ARIES RESIDENTIAL CARE INCFACILITY NUMBER:
361800210
ADMINISTRATOR:ROGOVIN, ROBERTFACILITY TYPE:
740
ADDRESS:17892 SYCAMORE STTELEPHONE:
(760) 821-9172
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: 6DATE:
04/05/2023
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Herminia Rogovin, Licensee and
Robert Rogovin Licensee and Administrator		TIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff mismanaged resident's medication.
Staff did not inform resident's authorized person of incidents.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with the Rogovins and explained the purpose of the visit. The investigation included a facility tour, file reviews, and interviews with relevant parties.

Allegation #1 “Staff mismanaged resident's medication” The allegation alleged that staff asked for medication refills when the medication was delivered five (5) days prior. The allegation also alleged that staff did not document when medications were given or by whom. The allegation further alleged that the staff withheld the resident's medication. LPA interview with the Licensee revealed that resident # 1 (R1) was in hospice, and the hospice nurses ordered medication for their residents. The Licensee stated that when the hospice nurses visit the facility, the nurses inquire about what medication is needed. The Licensee stated that they provided the containers for said medication to the hospice nurse to order it. LPA interview with the reporting party (RP) revealed that the facility never logged the medication and did not document when R1's medication was administered. RP stated the R1’s Ativan was not administered. LPA file review revealed that on November 20, 2021, a hospice nurse visited the facility as requested by the family.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
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 6
Control Number 56-AS-20220404153243
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: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210
VISIT DATE: 04/05/2023
NARRATIVE
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According to the hospice nurse report, “the facility staff is non-compliant with the current order and occasionally skipping medication for pain or anxiety, they state are providing when patient ask”. The hospice nurse’s report further stated that the nurse educated facility staff on the need for medication compliance.

Allegation # 2 “Staff did not inform resident's authorized person of incidents”. The allegation alleged that facility staff did not provide incident reports to the family or hospice. The allegation alleged that out of four (4) incidents, they received only two (2) reports from the facility. LPA Interview with the Licensee revealed that the administrator would notify the hospice company because the hospice company determines if the client needs to go to the hospital. The Licensee stated that the hospice company would notify the family, and the hospice company would send out a nurse to access the client. The Licensee stated that the administrator would send an incident report to licensing. LPA interview with the RP revealed that the facility never notified them about incidents surrounding R1. RP stated that they learned about R1’s incidents from R1. LPA file review revealed that on November 16, 2021, a hospice nurse visited the facility because R1’s authorized representative called the hospice company reporting that R1 contacted their authorized representative to report they fell. LPA file review also revealed that the facility did not notify our agency.

Based on the evidence gathered during the investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conduct were a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provide.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 56-AS-20220404153243
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: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/05/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/03/2023
Section Cited
CCR
87465(C)(2)
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87465 Incidental Medical and Dental Care (C) (2)

(2) Once ordered by the physician the medication is given according to the physician's directions.

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The licensee shall provide training in the section cited to all staff. Licensee shall also submit a letter of understanding to the Regional Office (RO) with training records by the POC due date.
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This requirement was not met as evidenced by:

Based on file review and interview, the licensee did not ensure that R1’s medication was given according to the physician’s direction.
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Type B
05/03/2023
Section Cited
CCR
87211
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87211 Reporting Requirements

(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following...

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The licensee shall provide training in the section cited to all staff. Licensee shall also submit a letter of understanding to the Regional Office (RO) with training records by the POC due date.
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This requirement was not met as evidenced by:

Based on file review and interview, the Licensee did not ensure to report unusual incident/injury to R1's responsible party.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
04/04/2022 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220404153243

FACILITY NAME:ARIES RESIDENTIAL CARE INCFACILITY NUMBER:
361800210
ADMINISTRATOR:ROGOVIN, ROBERTFACILITY TYPE:
740
ADDRESS:17892 SYCAMORE STTELEPHONE:
(760) 821-9172
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:6CENSUS: 6DATE:
04/05/2023
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Herminia Rogovin, Licensee and
Robert Rogovin Licensee and Administrator		TIME COMPLETED:
11:25 AM
ALLEGATION(S):
1
2
3
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9
Staff mismanaged resident's oxygen (O2)
Staff improperly stored resident's medication
Facility not kept clean.
Resident sustained a fall while in care.
Resident was slapped by another resident .
INVESTIGATION FINDINGS:
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5
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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with the Rogovins and explained the purpose of the visit. The investigation included a facility tour, file reviews, and interviews with relevant parties.

Allegation # 1 “Staff mismanaged resident's oxygen (O2)”. The allegation alleged that on two (2) occasions, resident #1’s (R1’s) oxygen was empty when the family took them to their medical appointments. The allegation also alleged that on September 26, 2021, R1 reported to the reporting party (RP) that they could not breathe and that their oxygen was not working. LPA interview with the Licensee revealed that R1 received hospice care, and the hospice company ordered the oxygen. Licensee stated that the hospice company supplied R1 with an electric oxygen machine and portable oxygen cylinders that are only appropriate for two (2) to three (3) hour use. Licensee stated that there was a problem with the electric oxygen machine, and the facility called the company to bring a new machine. Licensee stated that the facility did not use R1’s oxygen on other clients because the other clients have their oxygen supply.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 56-AS-20220404153243
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: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210
VISIT DATE: 04/05/2023
NARRATIVE
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LPA interview with the RP revealed that the RP picked up R1 on two (2) occasions, and the facility provided the RP with two empty oxygen cylinders for R1. RP stated the first incident, they went back and found a full oxygen cylinder the second incident, they did not. RP stated the second incident I had to take R1 to the dentist, and the facility had no oxygen cylinder for R1; therefore, the facility provides an electric portable oxygen machine. RP stated that R1 only had access to their oxygen once they arrived at the dentist's office and had access to an electrical outlet to plug up the portable oxygen machine. RP stated that when they addressed this issue with the Licensee or the administrator about the facility not having oxygen cylinders for use outside the facility. RP stated that the Licensee or Administrator would always blame the oxygen delivery service for the facility's ability to retain the oxygen cylinder for R1. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #2 “Staff improperly stored resident's medication”. The allegation alleged the R1’s medication was stored in the refrigerator with other food. LPA interview with the Licensee revealed that medication requiring refrigeration is stored in the back refrigerator. LPA interview with the RP revealed that they observed the medication on the side of the refrigerator where the butter is stored. LPA observed revealed that is storing medication in the refrigerator in a safe manner, the medication was stored in the refrigerator in lock boxes. LPA cannot attest to how the facility stored medication when this allegation was made; therefore, the finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 3 “Facility not kept clean”. The allegation alleged that the facility toilet was dirty for extended periods. LPA interview with the Licensee revealed that the facility is cleaned throughout the day. The Licensee stated that the facility’s detailed cleaning occurs when the clients are in bed. LPA interview with the RP revealed that the facility commode was full of feces for extended periods. LPA observed that the facility was clean and did not observe any dirty toilets. LPA cannot attest whether the facility was not kept clean when this allegation was made; therefore, the finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #4: “Resident sustained a fall while in care”. The allegation alleged that R1 slipped in her urine. LPA interview with the Licensee revealed that the facility staff would check if a client had an accident and the floor was wet. LPA interview with the RP revealed that R1 slipped in her urine in her bedroom; however, the RP did not know if R1 urinated trying to make it to their commode or slipped on urine on the floor that the facility failed to clean up. The finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20220404153243
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: ARIES RESIDENTIAL CARE INC
FACILITY NUMBER: 361800210
VISIT DATE: 04/05/2023
NARRATIVE
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Allegation #5 “Resident was slapped by another resident” The allegation alleged that R1 was slapped by resident #2 (R2). The allegation also alleged that a member of the facility staff advised RP that they were attempting to get R2’s medication adjusted. LPA interview with the RP revealed that R1 informed the RP that R2 slapped R1 on the leg as they were trying to walk by. The RP stated that they spoke with the Licensee about the incident and the Licensee. RP stated that they were trying to get R2’s physician to adjust their medication. The RP also stated that they were unaware of any issues between R1 and R2. LPA interview with the Licensee revealed that although the Licensee was not present when the incident occurred, their staff notified the Licensee about the incident. The Licensee stated that R1 and R2 did not get along. The Licensee stated that R1 and R2 were not roommates and did not enter each other’s rooms. The Licensee stated that R1 and R2 only saw each other in the facility's common areas, and the facility was doing all it could to separate the two (2) residents.

A finding of 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.

An exit interview was conducted and copy of this report was provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: 951-255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 04/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6