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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880996
Report Date: 02/10/2022
Date Signed: 02/10/2022 09:37:09 AM

Substantiated


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
02/02/2022 and conducted by Evaluator Rohit Lama
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220202090951
FACILITY NAME:TAMARIND SENIOR CARE, LLCFACILITY NUMBER:
361880996
ADMINISTRATOR:RAMAS, SOTERO CHANDLER IIIFACILITY TYPE:
740
ADDRESS:9545 TAMARIND AVETELEPHONE:
(909) 346-0292
CITY:FONTANASTATE: CAZIP CODE:
92335
CAPACITY:6CENSUS: 0DATE:
02/10/2022
UNANNOUNCEDTIME BEGAN:
08:29 AM
MET WITH:RAMAS III, SOTERO CHANDLER, AdministratorTIME COMPLETED:
09:40 AM
ALLEGATION(S):
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Staff are not proving access to a resident's record.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the complaint allegation listed above. LPA met with Sotero Chandler Ramas III , Adminstrator.

The investigation included interviews with Administrator, Outside Individual, and record review. The allegation states the facility staff failed to provide resident’s records to authorized representatives.
Investigation and interviews revealed that multiple attempts were made by the authorized representative of the resident (R1) to contact the facility. After several unsuccessful attempts, the authorized representative utilized a courier service (Titan) to mail the request on 1/10/2022 and a follow-up letter was also sent on 1/28/2022. Finally, the courier service was used to hand deliver teh same request on 2/2/2022. As of today, the requested records have not been provided to the authorized party. The Adminstrator acknowledges the delay and agrees to resolve the matter as soon as possible.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit LamaTELEPHONE: (951) 217-9826
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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 3
Control Number 18-AS-20220202090951
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: TAMARIND SENIOR CARE, LLC
FACILITY NUMBER: 361880996
VISIT DATE: 02/10/2022
NARRATIVE
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Based on LPA interviews conducted and a review of records, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division & Chapter number 87468.2(a)(19) are being cited on the attached LIC 9099D.

An exit interview was conducted, and a copy of this report was reviewed, and appeal rights were provided to the Administrator, whose signature on this form confirm receipt of the above-mentioned documents.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit LamaTELEPHONE: (951) 217-9826
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20220202090951
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: TAMARIND SENIOR CARE, LLC
FACILITY NUMBER: 361880996
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/15/2022
Section Cited
CCR
87468.2(a)(19)
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87468.2(a)(19) Additional Personal Rights of Residents in Privately Operated FacilitiesTo have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two (2) business days and at a cost that does not exceed the...
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The operator shall provide Resident’s records to authorized representative by POC Due Date (2/15/2022) and provide LPA with proof that the documents were provided.
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 ...community standard for photocopies.
Based on interviews and record review the licensee did not provide resident’s records to authorized representative when requested on 5/8/2020 and 6/19/2020 which poses a potential health and safety risk to resident(s) 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.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Rohit LamaTELEPHONE: (951) 217-9826
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3