361880599-3-29-2023-56-AS-EMAN-CRUTY8-20230515150819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880599
Report Date: 03/29/2023
Date Signed: 03/29/2023 12:49:19 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
03/24/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230324154731

FACILITY NAME:	LOTUS VILLA AND MEMORY CARE		FACILITY NUMBER:	361880599
ADMINISTRATOR:	DEBORAH P HIGGINS		FACILITY TYPE:	740
ADDRESS:	9448 CITRUS AVE		TELEPHONE:	(909) 355-6887
CITY:	FONTANA	STATE: CA	ZIP CODE:	92335
CAPACITY:	99	CENSUS: 42	DATE:	03/29/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rebecca Parra		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff engages in verbal altercations with residents in care.
Staff does not prevent the spread of communicable diseases.
Facility does not have adequate staffing to meet residents needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to initiate and deliver the findings for the above complaint allegations. LPA met with Facility Administrator Rebecca Parra who was informed of the purpose of my visit and the allegations listed above. The investigation consists of direct observations, records review, and interviews with staff and residents regarding the above allegations.

First Allegation: Staff engages in verbal altercations with residents in care.

Regarding first allegation: Staff engages in verbal altercations with residents in care. Licensing Program Analyst (LPA) Paola Guerrero conducted in person interviews with Staff #1 (S1), Staff #2 (S2), Staff #3 (S3) and Staff #4 (S4), who all stated that they have not witnessed staff members to engage in verbal altercations with residents. Staff#2 stated that when residents become agitated with staff/caregivers automatically the switch of a staff member or caregiver will be implemented to deescalate the situation.

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: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

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-20230324154731

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: LOTUS VILLA AND MEMORY CARE	FACILITY NUMBER: 361880599
	VISIT DATE: 03/29/2023

NARRATIVE

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LPA interviewed Resident#1 (R1), Resident#2 (R2), Resident#3 (#3), and Resident#4 who all stated that they have not experienced or witnessed staff engage in altercations with residents in care.

Second Allegation: Staff does not prevent the spread of communicable diseases.

Regarding second allegation: Staff does not prevent the spread of communicable diseases. Licensing Program Analyst (LPA) Paola Guerrero conducted a file review inspection of facility mitigation plan along with infection control plan and procedures LPA observed facility to have a plan in place which follows Community Care Licensing Division guidelines for COVID-19. LPA conducted a facility walkthrough and observed postings throughout the facility for proper cough etiquette, proper hand washing procedure, and/or social distancing guidelines. Currently the facility is COVID free last case reported was on 2/7/2023.

Third Allegation: Facility does not have adequate staffing to meet resident’s needs.

Regarding Third allegation: Facility does not have adequate staffing to meet resident’s needs. Licensing Program Analyst (LPA) Paola Guerrero interviewed Four (4) residents: Residents R1, R2, R3 and R4 confirmed that staff can meet their everyday needs. R1, R3, R2, stated that caregivers at the facility attend to their needs when needed. LPA also reviewed staffing schedule. Based on the schedule LPA observed that there is adequate staffing to support all shifts. LPA asked the Administrator what were to happen if a staff member was to call off. Administrator stated that caregivers will work a split shift, OT will be offered, and in worst case scenario a third-party providing agency will be utilized for coverage.

Based on the information obtained there is not enough evidence that the above-mentioned allegations occurred. Therefore, the allegations are deemed 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 Administrator Rebecca Parra 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: 03/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2023

LIC9099 (FAS) - (06/04)

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