361881019-2-16-2022-18-AS-EMAN-CCXUDM-20220328152945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881019
Report Date: 10/11/2021
Date Signed: 02/16/2022 10:30:24 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
09/13/2021 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210913125516

FACILITY NAME:	WILDWOOD CANYON VILLA		FACILITY NUMBER:	361881019
ADMINISTRATOR:	OSORIO, JULIUS		FACILITY TYPE:	740
ADDRESS:	33951 COLORADO ST		TELEPHONE:	(909) 446-0405
CITY:	YUCAIPA	STATE: CA	ZIP CODE:	92399
CAPACITY:	130	CENSUS: 64	DATE:	10/11/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Julius Osorio		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not assisting resident with incontinence needs.
Staff are not ensuring resident has clean linens.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to commence a complaint investigation. LPA Brown identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator Julius Osorio.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The first allegation indicates that staff are not assisting resident with incontinence needs. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Records review and interview with Resident 1-11 and Staff 1-11 indicated that staff are assisting residents with their incontinence needs. Investigation also revealed that staff checks each resident every two (2) hours or more if needed to make sure they are assisting with their residents’ incontinence needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

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-20210913125516

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: WILDWOOD CANYON VILLA	FACILITY NUMBER: 361881019
	VISIT DATE: 10/11/2021

NARRATIVE

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The second allegation indicates that staff are not ensuring resident has clean linens. LPA Brown did not obtain evidence to corroborate the allegation. Interview with Resident 1-11 and Staff 1-11 and records review indicated that residents’ bed linens were changed once per week by housekeeping and if residents soiled their bed, caregivers changed the bed linens immediately and then washed it afterwards.

Based on the evidence, the allegations that staff are not assisting resident with incontinence needs and staff not ensuring resident has clean linens are UNSUBSTANTIATED. A finding that the 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, therefore the allegation is unsubstantiated at this time.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2021

LIC9099 (FAS) - (06/04)

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