361800479-10-25-2022-56-AS-EMAN-CLNPXK-20221130104227

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800479
Report Date: 10/25/2022
Date Signed: 10/25/2022 02:44:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
10/18/2022 and conducted by Evaluator Natalie Ibarra

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20221018151053

FACILITY NAME:	ASHER ESTATE		FACILITY NUMBER:	361800479
ADMINISTRATOR:	LEIPER, GRETCHEN		FACILITY TYPE:	740
ADDRESS:	2487 EUCLID CRESCENT EAST		TELEPHONE:	(909) 755-1157
CITY:	UPLAND	STATE: CA	ZIP CODE:	91784
CAPACITY:	6	CENSUS: 6	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Robert Berry		TIME COMPLETED:	02:53 PM

ALLEGATION(S):

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Staff denied resident from wearing her prosthetic feet
Unqualified staff dispensing residents medication
Staff are not providing adequate food service for residents
Staff did not ensure resident ate
Staff are mocking resident
Staff are making inappropriate comments towards residents
Staff are not providing residents with hygiene care
Facility doors are not wheelchair accessible

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Natalie Ibarra and Victoria Chitgian made an unannounced visit to the facility to investigate the above allegations. LPAs met with Licensee Robert Berry and explained the purpose of today's visit. The investigation consisted of interviews with pertinent parties and records review.

The first allegation indicates staff denied resident from wearing her prosthetic leg. Interviews with Staff #1 (S1) and Staff #2 (S2) stated staff never denied Resident #1 (R1) from wearing prostethic legs. Staff are not trained in applying prosthetic feet and therefore not able to put nor assist R1 with prosthetics.LPAs reviewed R1's Physician Report that states R1 does wear prothetics but does not state whether or not R1 needs assistance with put prosthetics on.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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-20221018151053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ASHER ESTATE	FACILITY NUMBER: 361800479
	VISIT DATE: 10/25/2022

NARRATIVE

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The second allegation indicates unqualified staff dispensing residents medication. Interviews S1, S2, and S3 stated all staff have been trained in medication dispensing. LPAs were able to verify staff are training in medication dispensing.

The third allegation indicates staff are not providing adequate food service for residents. Interviews with S1, S2 and S3 stated facility does provide adequate food serve for residents. S1 and S2 stated facility has never run out of groceries and are bought weekly and also as needed. S1 and S2 stated Resident #2 (R2) is the only resident that is on a special diet. S3 stated meals provided to residents are healthy. Interview with R4 stated facility does provide good meals to residents and has never been out of food. LPAs observed facility had the at least 2 days of perishable and 7 days of non perishable food in stock. LPAs reviewed R2's file that stated they are on a puree diet.

The fourth allegation indicates staff did not ensure resident ate. S1, S2, and S3 stated staff always ensure residents eat. S1 stated R3 has never been left at the at the dining table for over 13 hours and staff always assist R3 with eating. LPAs interviewed R3's Responsible Party (RP) that stated staff have never left R3 for hours at the dining table. Staff always have assisted R3 with eating. RP also stated R3 does like to sit at times at the dining table and it is their right to do so.

The fifth allegation indicates staff are mocking resident. Interviews with S1, S2, and S3 stated they have never witnessed staff mock any of the residents in care. R4 stated they have never witnessed staff mock residents in care

The sixth allegation indicated staff are making inappropriate comments towards residents. Interviews with S1, S2, and S3 stated they have never witnessed staff make any type of inappropriate comments to residents. Interview with R4 stated they have never witnessed staff make inappropriate comments to residents.

The seventh allegation indicates staff are not providing residents with hygiene care. S1, S2, and S3 stated residents hygiene care are being met. S1 and S2 stated facility does have basic hygiene products for the residents. They also stated resident showers and bowel movements are logged. S3 stated they brush residents teeth and hair and also showers residents. LPAs reviewed facility chart that shows when residents are bathed and that bowel movements are logged. LPAs also observed facility does have hygiene products.

The eight allegation indicates facility doors are not wheelchair accessible. S1 and S2 stated facility doorways are wide enough to allow wheelchairs to go through. S1 stated all doorways are 36 inches wide for wheelchairs.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20221018151053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ASHER ESTATE	FACILITY NUMBER: 361800479
	VISIT DATE: 10/25/2022

NARRATIVE

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S3 stated there is not a problem with the doors being wheelchair accessible. LPAs observed door ways are wide enough for wheelchairs throughout the facility. Facility also has ramps throughout as well for wheelchairs.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations 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 and a copy of this report was discussed and provided to licensee Robert Berry

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie Ibarra	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

LIC9099 (FAS) - (06/04)

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