361880835-4-21-2021-18-AS-KCLS-CNU2RR-20230207163758

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880835
Report Date: 04/20/2021
Date Signed: 04/21/2021 05:13:04 PM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/12/2020 and conducted by Evaluator Javier Prieto

COMPLAINT CONTROL NUMBER: 18-AS-20200812142753

FACILITY NAME:	VISTA BLUE MOUNTAIN		FACILITY NUMBER:	361880835
ADMINISTRATOR:	TRABUCCO, MEGAN		FACILITY TYPE:	740
ADDRESS:	22325 BARTON ROAD		TELEPHONE:	(909) 420-0153
CITY:	GRAND TERRACE	STATE: CA	ZIP CODE:	92313
CAPACITY:	150	CENSUS:	DATE:	04/20/2021
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Kelly Lara		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff left residents in diapers with urine and feces for 4 days

Facility does not have sufficient staff to care for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto contacted administrator Kelly Lara to discuss that conclusion of complaint investigation that alleged that staff left residents in diapers with urine and feces for 4 days and facility does not have sufficient staff to care for residents. LPA Prieto interviewed resident #1 (R1) in question, who states that staff attends to R1's needs related to grooming, cleaning and bathing. R1 states that R1 is able to bath and dress on R1's own, but when assistance is needed, staff is called and needs are met.

Administrator Lara also provided LPA Prieto with showering schedule of residents at facility providing adequate showering care. Staff #1 states R1 is seen everyday for medication distribution, and has not observed R1 or any other resident at facility with diapers urine or feces for multiple days. LPA obtained employee work schedule which show sufficient med tech staff, AM, PM and NOC staff providing care for residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2021

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 18-AS-20200812142753

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: VISTA BLUE MOUNTAIN	FACILITY NUMBER: 361880835
	VISIT DATE: 04/20/2021

NARRATIVE

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Based on the information obtained there is not enough evidence that staff left residents in diapers with urine and feces for 4 days and facility does not have sufficient staff to care for residents . Therefore, the allegations that are deemed UNSUBSTANTIATED at this time. 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, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2021

LIC9099 (FAS) - (06/04)

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