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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880879
Report Date: 08/28/2024
Date Signed: 08/28/2024 06:15:01 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
08/01/2023 and conducted by Evaluator Magda Malcore
COMPLAINT CONTROL NUMBER: 56-AS-20230801155249
FACILITY NAME:BIG HEARTS COTTONWOOD, INC.FACILITY NUMBER:
361880879
ADMINISTRATOR:MANALAD, RONALDFACILITY TYPE:
735
ADDRESS:25556 COTTONWOOD RDTELEPHONE:
(909) 328-2446
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:4CENSUS: 4DATE:
08/28/2024
UNANNOUNCEDTIME BEGAN:
05:45 PM
MET WITH:Reyke KomaligTIME COMPLETED:
06:20 PM
ALLEGATION(S):
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Staff yells at resident in care
Staff speaks inappropriately to resident in care
Staff does not ensure facility is free of bed bugs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Magda Malcore and Becky Mann conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Direct Support Provider (DSP) Reyke Komalig, who was informed of today’s visit.

Regarding the allegation, staff yells at resident in care, two (2) resident interviews reveal staff have yelled at them. One (1) resident interview reveals they have witnessed staff yell at a resident. Four (4) staff interviewed deny yelling at residents in care. The Administrator stated that he has had training with staff about yelling at residents.
Regarding the allegation, staff speaks inappropriately to resident in care, two (2) out of four (4) resident interviews reveal that staff have made inappropriate comments about their weight. Four (4) staff interviewed deny that they have made inappropriate comments towards a resident. The Administrator stated that he has had training with staff about calling residents “fat.”
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
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 4
Control Number 56-AS-20230801155249
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: BIG HEARTS COTTONWOOD, INC.
FACILITY NUMBER: 361880879
VISIT DATE: 08/28/2024
NARRATIVE
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Regarding the allegation, staff does not ensure facility is free of bed bugs, The Administrator stated he ensured the facility was rid of bed bugs by contracting an exterminator company. Review of exterminator service invoices reveal no treatment for bed bugs.

Based on record reviews and interviews, the allegations is Substantiated. A finding that the complaint is substantiated means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to DSP Komalig at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20230801155249
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: BIG HEARTS COTTONWOOD, INC.
FACILITY NUMBER: 361880879
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2024
Section Cited
CCR
80072(a)(1)
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(a)Except for children’s residential facilities, each client shall have personal rights which include...:
(1)To be accorded dignity in his/her personal relationships with staff and other persons...this requirement is not met as evidenced by:
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The Licensee/Administrator agreed to conduct inservice training with staff on the regulation cited by POC due date.
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the Licensee did not comply with section cited by two (2) resident interviews reveal staff have yelled at them. One (1) resident interview reveals they have witnessed staff yell at a resident, which poses an immediate health, safety or personal rights risk to persons in care.
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Type A
08/29/2024
Section Cited
HSC
80072(a)(3)
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(a) Except for children’s residential facilities, each client shall have personal rights which include…(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule…mental abuse…this requirement is not met as evidenced by:
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The Licensee/Administrator agreed to conduct inservice training with staff on the regulation cited by POC due date.
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the Licensee did not comply with section cited above by, staff have made inappropriate comments toward residents. The Administrator provided staff training regarding calling residents “fat.” which poses an immediate health, safety or personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20230801155249
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: BIG HEARTS COTTONWOOD, INC.
FACILITY NUMBER: 361880879
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/28/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/29/2024
Section Cited
CCR
80087(a)(1)
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Buildings and grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. (1)The licensee shall take measures to keep the facility free of flies and other insects. This requirement is not met as evidenced by:
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The licensee/Administrator shall provide to the licensing agency current documentation of exterminator bed bug treatment by POC date.
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The Licensee did not comply with the section cited above by the exterminator invoice provided does not show treatment for bed bugs; which poses an immediate health, safety or personal rights risk to persons in care.

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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.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/28/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4