361880786-1-6-2023-56-AS-KCLS-CMU35G-20230106165643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880786
Report Date: 01/06/2023
Date Signed: 01/06/2023 11:56:08 AM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/08/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220808151842

FACILITY NAME:	SUMMERFIELD OF REDLANDS		FACILITY NUMBER:	361880786
ADMINISTRATOR:	TURNER, DANICA J		FACILITY TYPE:	740
ADDRESS:	1319 BROOKSIDE AVENUE		TELEPHONE:	(909) 793-9500
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92373
CAPACITY:	75	CENSUS: 45	DATE:	01/06/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Delcie Mucha- Resident Service Director		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

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Allegation #1- Licensee is not following admission's agreement for bathing and hygiene.
Allegation #2- Staff failed to meet residents needs resulting in bed sores.
Allegation #3-Licensee is not informing POA of change of medical conditions
Allegation #4- Resident is not being fed nutritional meals resulting in weight loss.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Bernadette Allen made an unannounced visit to the facility for the purpose of delivering findings on the complaint(s) listed above. Upon arriving to the facility the administrator Hedi Charette or Delcie Mucha was not avaliable. Delcie was called and she requested that LPA Allen give her 15-20 Minutes to arrive to the facility. Delcie arrived at 11:45 AM and she was informed of the purpose of the visit.

During LPA Allen investigation documents were reviewed, twelve (12) staff members were interviewed and six (6) residents responsible parties. LPA Allen observed Resident 1 (R1) records and documentation shows that staff members were following the admissions agreement for bathing/hygiene needs. The documents reviewed also revealed that staff did meet the residents needs by contacting their responsible party and their physician requesting outside care providers because of (R1) level of care changing; along with additional monitoring from the support staff at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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-20220808151842

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
, CA 92507

FACILITY NAME: SUMMERFIELD OF REDLANDS	FACILITY NUMBER: 361880786
	VISIT DATE: 01/06/2023

NARRATIVE

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Records and documentation also showed that the residents responsible party and physician had been notified of (R1’s) change in eating habits and medical conditions.
Based on LPA Allen’s interviews, documentation, and record review the four (4) allegations listed above are deemed Unsubstantiated.

A finding that a complaint is Unsubstantiated means 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, and a copy of this report with the appeal rights was discussed with Delcie Mucha Resident Services Director at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC9099 (FAS) - (06/04)

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