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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880786
Report Date: 09/22/2021
Date Signed: 09/23/2021 09:28:18 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/05/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210105132153
FACILITY NAME:SOMERFORD PLACE-REDLANDSFACILITY NUMBER:
361880786
ADMINISTRATOR:TURNER, DANICA JFACILITY TYPE:
740
ADDRESS:1319 BROOKSIDE AVENUETELEPHONE:
(909) 793-9500
CITY:REDLANDSSTATE: CAZIP CODE:
92373
CAPACITY:75CENSUS: 39DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Danica TurnerTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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9
Neglect resulting in death of resident
Inadequate staffing to meet resident needs
Staff did not maintain a comfortable temperature in the facility
Uncleared adults are working in the facility
Facility does not have a signaling system in resident rooms
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to deliver findings for the above allegations. LPA met with Administrator, Danica Turner, and discussed the purpose of the visit. The investigation consisted of records review, direct observation, and interviews with staff and residents.

In regards to allegation #1, LPA interviewed Registered Nurse (RN) and Licensed Vocational Nurse (LVN), who both stated that Resident #1 (R1) passed from complications stemming from COPD diagnosis. LVN stated that they provided services for R1 about 1-2 times a week and stated that R1 was experiencing a “steady decline” prior to R1’s death. Both RN and LVN denied that the R1’s death was a result of neglect by the facility. RN stated that R1 was receiving hospice services for COPD diagnosis from January 2020 through December 2020. RN stated there was no documentation of a “bleeding issue.” LPA interviewed R1’s daughter who stated that they did not believe R1 passed as a result of neglect by facility staff. R1’s daughter stated that they received a death certificate which listed COPD and Emphysema as R1’s cause of death.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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 2
Control Number 18-AS-20210105132153
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SOMERFORD PLACE-REDLANDS
FACILITY NUMBER: 361880786
VISIT DATE: 09/22/2021
NARRATIVE
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LPA interviewed Staff #1 (S1) who stated that R1 was being seen by the hospice agency often. S1 stated that the facility staff were providing appropriate care for R1 and denied that R1’s passing was a result of neglect by the facility. S1 stated that they were unaware of a “bleeding issue.”

In regards to allegation #2, LPA interviewed S1 who stated that the facility has four to six care staff at the facility during the AM, PM, and NOC shift. S1 stated that the facility also has four additional staff members that can assist with resident care if needed. LPA interviewed Resident #2 (R2), Resident #3 (R3), and Resident #4 (R4) who all stated that they believe the facility has adequate staff to meet resident needs. LPA reviewed the facility's staff schedule which confirmed that there are four to six care staff scheduled to be at the facility during each shift.

In regards to allegation #3, upon arrival to the facility, LPA observed the facility's temperature to be comfortable and several thermostat's reading at 75 degrees F. LPA interviewed R2 who stated that the facility had issues with temperature control in the past; however, it has been fixed. LPA interviewed R3 who stated that the facility's temperature is "fine." LPA interviewed S1 who stated that the facility's temperature is kept at 75 degrees F and adjusted as needed.

In regards to allegation #4, LPA reviewed the facility's staff schedule and roster against the roster on Community Care Licensing Division's Guardian roster list and observed that all persons listed on facility schedule were eligible to work and associated to the facility. LPA interviewed S1 who stated that the facility roster is checked and updated frequently. S1 stated that persons without clearance do not get scheduled to work until they have been cleared appropriately with the Department.

In regards to allegation #5, LPA inspected a sample of resident bedrooms and common restrooms, and observed that those rooms were equipped with pull cord signaling systems.

Based on evidence obtained during the investigation, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that although the allegations 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 was discussed and a copy of the report was provided to the Administrator via email.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2