361800458-9-16-2024-56-AS-NBRN-DA526F-20241016170700

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800458
Report Date: 09/16/2024
Date Signed: 09/16/2024 12:33:25 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
09/10/2024 and conducted by Evaluator Renese Howell-Small

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240910111214

FACILITY NAME:	ADVANTAGE CARE FACILITY		FACILITY NUMBER:	361800458
ADMINISTRATOR:	TORRES, MELVIN		FACILITY TYPE:	740
ADDRESS:	27438 STRATFORD STREET		TELEPHONE:	(909) 910-5629
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	6	CENSUS: 5	DATE:	09/16/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Melvin Torres, Administrator		TIME COMPLETED:	12:35 PM

ALLEGATION(S):

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Facility staff is a joint tenant on resident's bank account.

INVESTIGATION FINDINGS:

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On 9/16/24 at 9:30AM, Licensing Prorgam Analysts (LPA's) Renese Howell-Small and Melody Brown conducted an unannounced visit to the facility to commense a compLlaint investigation. LPA's Small and Brown were greeted and granted entrance by a staff member and icensee/Administrator Melivin Torres was contacted by a staff member and informed of the reason for our visit. LPA's Small and Brown identified themselves and discussed the purpose of the visit to staff#3 (S3), during the visit Licensee/Administrator Torres arrived and met with LPA's Small and Brown and discussed the elements of the allegation with Licensee/Administrator, Torres.

The investigation was conducted by LPA's Small and Brown. The investigation consisted of file review and interviews with relevant parties. The allegation indicated that Facility staff is a joint tenant on resident's bank account.LPA's Small and Brown were able to obtain evidence to corroborate the allegation. Interview with Resident 1 (R1) indicated that R1 added Staff#2 (S2) as a beneficiary to R1's bank account. R1 reported to ***Continuation in LIC9099C***

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

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-20240910111214

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ADVANTAGE CARE FACILITY	FACILITY NUMBER: 361800458
	VISIT DATE: 09/16/2024

NARRATIVE

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LPA's Small and Brown that R1 made the change of beneficiary to R1's bank account because it was S2 who was taking care of R1.

LPA's Small and Brown interviewed Staff 2 (S2) and S2 confirmed that R1 made S2 as the beneficiary to R1's account on 08/21/2024. In addition, Licensee/Administrator, Melvin Torres confirmed with LPA's Small and Brown that R1 made S2 the beneficiary on R1's account on 08/21/2024. Moreover, Licensee/Administrator, Torres reported to LPA's Small and Brown that S2's a relative and has not been working at the facility since 2021. Also Licensee/Administrator, Torres added that S2 works privately for R1.

Based on LPA's Small and Brown's interviews and review of records, the preponderance of evidence standard has been met. Therefore the allegation Facility staff is a joint tenant on resident's bank account is found to be SUBSTANTIATED. Health and Safety Code, Title 22, Division 6 is being cited on the attached LIC9099D.

An exit interview was conducted where this report LIC9099, LIC9099D and Appeal Rights were discussed and were provided to Licensee/Administrator, Melvin Torres.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20240910111214

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ADVANTAGE CARE FACILITY	FACILITY NUMBER: 361800458
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/16/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/14/2024 Section Cited HSC 1569.269(a)(29)(D)	1 2 3 4 5 6 7	1569.269 Enumerated Rights; severability (a)Residents of residential care facilities for the elderly shall have all of the following rights: (29)To manage their financial affairs. A licensee shall not require residents...Except as provided in approved continuing care agreements, a licensee, or a spouse, domestic partner, relative...(D) Become or act as a joint tenant on any account with a resident. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated to cease S2 as the beneficiary to R1's bank account and submit proof to LPA Renese Howell-Small on Plan of Correction (POC) due date.
	8 9 10 11 12 13 14	based on interviews and record review, the Licensee did not comply with the section cited above by allowing Staff 2 (S2) as Resident 1's (R1) beneficiary to R1's bank account on 08/21/2024, which poses a potential health, safety, and personal rights risk to resident in care.	8 9 10 11 12 13 14	Licensee stated to submit signed statement of understanding on HSC 1569.269(a)(29)(D) and a statment that will reflect that S2 will no longer be R1's beneficiary on R1's bank account to LPA Small on POC due date.
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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.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024

LIC9099 (FAS) - (06/04)

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