361880599-3-2-2023-56-AS-NBRN-CQEP9A-20230330110648

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880599
Report Date: 03/02/2023
Date Signed: 03/02/2023 02:57:01 PM

Substantiated

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
02/27/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230227160248

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:	02:55 PM

ALLEGATION(S):

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Staff do not provide a comfortable temperature for the residents

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 allegation.

Allegation One: Staff do not provide a comfortable temperature for the residents.

Licensing Program Analyst (LPA) Paola Guerrero conducted a check sampling of the rooms for the purpose of checking the thermostat temperature. LPA inspected room AL 102,104, and 108 to be under the heating requirement as stated on title 22, regulation 87303(a)(2). It was stated by the facility Administrator that the heaters in room AL 102,104, and 108 are currently being serviced. During the visit LPA spoke to the residents in room number 102 and 108 and stated that with this cold weather conditions that their rooms have been cold and have brought up the concern to the facility.

Substantiated

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)

Page: 1 of 5

Control Number 56-AS-20230227160248

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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LPA observed that no portable heaters were given as temporary use. LPA found that heating system in room AL 102,104, and 108 was in disrepair.

Based on the evidence gathered during investigation, the above allegation is Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Title 22 regulations 87303(a)(1) from division 6, chapter, article 6, is being cited on the attached LIC 9099 D.
An exit interview was conducted, and a copy of this report along with the appeal rights were discussed and provided to Facility Administrator Rebecca Parra.

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)

Page: 2 of 5

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
02/27/2023 and conducted by Evaluator Paola Guerrero

COMPLAINT CONTROL NUMBER: 56-AS-20230227160248

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:	02:55 PM

ALLEGATION(S):

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Staff behavior poses as a risk to the residents while in care

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 allegation listed above. The investigation consists of direct observations, records review, and interviews with staff and residents regarding the above allegation.

Allegation two: Staff behavior poses as a risk to the residents while in care

Licensing Program Analyst (LPA) Paola Guerrero interviewed Five (5) staff members who all stated that all staff members work well with one another and respect one another and stated that residents needs and care come first. Staff also stated thaty they have not witnessed any bad staff behavior that can pose as a risk to residents while in care. LPA interviewed Five (5) residents who all stated that they enjoy living at the facility and that staff members/caregivers treat them with respect and feel safe at the facility.

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)

Page: 3 of 5

Control Number 56-AS-20230227160248

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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Residents also stated that they have never witnessed staff members to be disrespectful to one another or other residents while in care therefore LPA found allegation to be Unsubstantiated.

Unsubstantiated- Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations is 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)

Page: 4 of 5

Control Number 56-AS-20230227160248

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/31/2023 Section Cited CCR 87303	1 2 3 4 5 6 7	87303 Maintenance and Oparation (a) The facility shall be clean, safe, sanitary and in good repair at all times...(1) The facility shall hear rooms that residents occpy to a minimum of 68 degreesF, (20 degreesC).. This requirement is not met by evidence by:	1 2 3 4 5 6 7	Administrator acknowledges the importance of having a facility in good repair. Administrator stated that residents with non working heaters will be relocated upstairs while heating system gets repaired. Administrator will provide invoices indicating heating systems have been reapired. And will email documentation to CCLD on 3/31/2023
	8 9 10 11 12 13 14	Based on obeservation, interviews and record review, the licensee did not ensure to maintain mainenance and operattion, which poses a possible Health, Safety, or Personal Rights to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

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 appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 5