361880599-3-2-2023-56-AS-NBRN-CQEPCA-20230330111136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880599
Report Date: 03/02/2023
Date Signed: 03/02/2023 04:11:12 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
03/01/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230301145020

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: 37	DATE:	03/02/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Rebecca Parra		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Residents are not properly cared for.
Facility is dirty.
Facility administrator is not qualified.
Facility is malodorous

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 allegations.

Allegation One: Staff handled resident in a rough manner.

Licensing Program Analyst (LPA) Paola Guerrero interviewed Five (5) staff members who all stated that they have not witnessed staff/caregivers handle residents in a rough manner. Staff stated that when residents become combative or uncooperative then another caregiver will be assigned to the resident to address the situation. LPA interviewed Five (5) residents all who stated that they have not witnessed or experienced staff handle residents in a rough manner. Residents expressed that they enjoy living at the facility and that staff members are nice and respectful and attend their needs at a timely manner.

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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

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-20230301145020

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: 03/02/2023

NARRATIVE

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Based on the interviews and observations conducted LPA determined the allegation to be 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.

Allegation two: Residents are not properly cared for.

Licensing Program Analyst (LPA) Paola Guerrero interviewed Five (5) staff members who all stated that facility provide pendants for residents to use when needed care or assistance in addition staff also stated that staff/caregivers carry walkie talkies to respond to residents needs when needed. LPA interviewed Five (5) residents all who stated that their needs and care are being met by caregivers and staff. Residents also stated that staff goes out of their way to attend their needs in a timely manner when residents need assistance.

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.

Allegation three: Facility is dirty.

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.

Allegation four: Facility administrator is not qualified.

Licensing Program Analyst (LPA) Paola Guerrero conducted a record review and observed administrator certification, 40hr certification class, and further documentation to determine that the assigned Administrator possess the required requirements and documentation to be qualified. LPA Paola Guerrero interviewed Five (5) staff members who all stated that facility is under new ownership and the new Administrator ensures that the facility needs are being met. Staff also stated that the new administrator has good attitude and cares for the residents. Based on the interviews and observations conducted LPA determined allegation to be 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.

Allegation five: Facility is malodorous.

Licensing Program Analyst (LPA) Paola Guerrero conducted a tour of the facility and was accompanied by Facility Administrator Rebecca Parra. While on tour LPA observed facility to be in good condition. LPA inspected room 102, 107, 108, 104, and 110 to be well furnished and clear of obstruction and odor free bathrooms were also clean and well sanitized. LPA tour dining area and activity room area all to be in good and clean condition and free of odor. LPA interviewed five (5) staff members who stated that house keeping is done daily and rooms are cleaned daily. LPA interviewed five (5) residents who stated facility ensures that their hygiene is maintained daily to prevent odors. Residents also stated that at times some residents refuse diaper change and at times odor can be present. Residents also stated that caregivers ensure that residents remain clean to avoid odors. Based on the interviews and observations conducted LPA determined allegation to be 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 the administrator 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: 03/02/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

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