361800429-8-22-2023-56-AS-KCLS-CV2NCJ-20230825102046

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800429
Report Date: 08/22/2023
Date Signed: 08/22/2023 12:16:32 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
11/08/2022 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221108104316

FACILITY NAME:	HELPING HEARTS BONANZA		FACILITY NUMBER:	361800429
ADMINISTRATOR:	MANUEL SOTO		FACILITY TYPE:	772
ADDRESS:	14516 BONANZA ROAD		TELEPHONE:	(909) 771-9940
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	10	CENSUS: 10	DATE:	08/22/2023
		UNANNOUNCED	TIME BEGAN:	11:53 AM
MET WITH:	Frank Pesqueira, Program Director		TIME COMPLETED:	12:22 PM

ALLEGATION(S):

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Staff are not addressing resident’s medical needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Program Director Frank Pesqueira and explained the purpose of the visit. The investigation included facility tours, file reviews, and interviews with relevant parties.

The allegation alleged that resident #1 (R1) is declining rapidly. The allegation alleged that on November 7, 2022, R1 remained in bed all day and did not shower. The allegation alleged that R1 complained of pain throughout their entire body. The allegation alleged that R1 was taken to their emergency appointment two (2) weeks ago and sent back to the facility without a diagnosis. LPA Nickolas' interview with the Program Director revealed that R1 had seen various doctors for their condition. LPA Nickolas' interview with staff #1 (S1) revealed that S1 confirmed R1's declining condition and acknowledges that R1 is taken to the doctor by the Program Director. However, S1 states that R1's condition is not improving. LPA Nickolas' was unable to interview R1' during the initial complaint investigation visit because R1 was in the hospital.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

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-20221108104316

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: HELPING HEARTS BONANZA	FACILITY NUMBER: 361800429
	VISIT DATE: 08/22/2023

NARRATIVE

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LPA Nickolas interviewed eight (8) residents in care, who all stated that the facility staff takes them to the doctor when needed. During today's visit, LPA Nickolas confirmed that R1 no longer resides at the facility. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

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.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2023

LIC9099 (FAS) - (06/04)

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