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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880786
Report Date: 12/14/2023
Date Signed: 12/14/2023 02:12:42 PM


Document Has Been Signed on 12/14/2023 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:SUMMERFIELD OF REDLANDSFACILITY NUMBER:
361880786
ADMINISTRATOR:HEDI CHARETTEFACILITY TYPE:
740
ADDRESS:1319 BROOKSIDE AVENUETELEPHONE:
(909) 793-9500
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:75CENSUS: 45DATE:
12/14/2023
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Hedi Charette AdministratorTIME COMPLETED:
02:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Bernadette Allen met with Hedi Charette Administrator at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office 12/14/2023 at 1:50 PM to initiate a Case Management Office Visit.

LPA Allen requested that Hedi Charette come to the office to sign an amended complaint investigation control number 56-AS-20221102154307 that was conducted on 2/28/2023. The report was missing an allegation and investigation information. During the investigation it was determined that on 10/29/2022 an incident occurred while S1 was assisting R1 with their shoes when R1 pulled her hair and S1 grabbed R1’s hands and place her fingers into R1’s hand to remove her hair from R1’s hands.

On 10/30/2022, interviews revealed there was significant bruising to R1's hands and facility staff did not seek medical attention at the time of observing R1’s bruised hands. It was not until 11/1/2022 that the administrator ordered a mobile imaging technician to come to the facility and to x-ray of R’1’s right hand.

Based on interviews, observations, and medical records the facility is being cited for not seeking medical attention in a timely manner.

A deficiency is being cited on the attached LIC 9099-D.

An exit interview was conducted where this report was discussed, and a copy was provided to Hedi Charette Administrator at the conclusion of the visit with appeal rights.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/14/2023 02:12 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507


FACILITY NAME: SUMMERFIELD OF REDLANDS
FACILITY NUMBER: 361880786

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/15/2023
Section Cited
CCR
87465(a)(1)

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INCIDENTAL MEDICAL & DENTAL CARE The licensee shall arrange, or assist in arranging, for medical & dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on file review & interviews, the licensee failed to seek
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The licensee has agreed to provide in-service training on the cited regulation to all staff to ensure medical care is arranged in a timely manner along with a statement of understanding signed by all staff by the POC date of 12/15/2023.
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medical attention in a timely manner it was 2 days before facility staff arranged for appropriate medical care for R1.
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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: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette AllenTELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:
DATE: 12/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
LIC809 (FAS) - (06/04)
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