361800479-1-18-2024-56-AS-EMAN-CZZPFH-20240131101646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800479
Report Date: 01/18/2024
Date Signed: 01/18/2024 11:30:38 AM

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
10/20/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231020155702

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: 5	DATE:	01/18/2024
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Robert Barry		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not following resident's wound care plan
Staff threatened resident in care
Staff do not ensure there is adequate amounts of food available at the facility for residents in care
Resident records are not properly maintained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Robert Barry and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff are not following resident's wound care plan. During interviews and record review LPA observed hospice documentation pertaining to resident indicating Resident #1 is receiving wound care treatment by hospice. Based on documentation LPA observed Hospice agency (VITA) to be providing the needed wound care treatment for Resident #1.

Second allegation, Staff threatened resident in care. LPA conducted interviews with residents all residents denied being threatened by staff while in care. LPA conducted interviews with staff and all staff denied threatening residents in care along with witnessing staff threatening residents while in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

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-20231020155702

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: 01/18/2024

NARRATIVE

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Third allegation, Staff do not ensure there is adequate amounts of food available at the facility for residents in care. During inspection LPA inspected facility fridge and observed adequate amount of Non-perishable and perishable food supply to be sufficient for number of residents in care.

Fourth allegation, Resident records are not properly maintained. During review of records LPA observed facility to have a proper designated storage space for resident’s/staff files. LPA observed facility to have all documentation properly filed upon the collection of resident’s records. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Robert Barry at the end of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC9099 (FAS) - (06/04)

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