361881048-4-7-2023-56-AS-KCLS-CQSV37-20230411160417

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881048
Report Date: 04/07/2023
Date Signed: 04/07/2023 10:33:56 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
06/22/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220622162817

FACILITY NAME:	AQUA RIDGE OF MONTCLAIR		FACILITY NUMBER:	361881048
ADMINISTRATOR:	MONIQUE DEL JUNCO		FACILITY TYPE:	740
ADDRESS:	9631 MONTE VISTA AVE		TELEPHONE:	(909) 483-2782
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY:	115	CENSUS: 37	DATE:	04/07/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Monique Del Junco- Administrator		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Insufficient staffing to meet residents’ needs
Untrained staff
Staff mismanaged resident’s medication
Staff did not re-position residents as instructed
Staff did not provide a safe environment

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to investigate and deliver findings for the above allegations. LPA Allen identified herself and met Administrator Monique Del Junco.

ALLEGATION 1- Insufficient staffing to meet residents’ needs-
Upon arrival to the facility LPA observed staff members throughout the facility. LPA also obtained the staff roster and currently there are (27) twenty-seven staff members employed. Based on observations and documentation there is enough staff to care for the residents. During the visit LPA observed five (5) staff members assisting the residents in the dining area of the memory care unit.

ALLEGATION 2- Untrained staff-
LPA received a total of (27) twenty -seven staff members training documents which all trainings apprear to current.

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: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

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-20220622162817

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: AQUA RIDGE OF MONTCLAIR	FACILITY NUMBER: 361881048
	VISIT DATE: 04/07/2023

NARRATIVE

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ALLEGATION 3- Staff mismanaged resident’s medication-

LPA observed six (6) Residents files and their medications were administered as prescribed by their physicians.

ALLEGATION 4- Staff did not re-position residents as instructed-

LPA interviewed two (2) residents that required assistance and they have stated assistance is always provided as needed. The resident’s records were reviewed and there are no doctor’s orders requiring re-positioning.

ALLEGATION 5- Staff did not provide a safe environment- LPA toured the facility inside and out and there were no health and safety concerns.

Based on the observations, interviews, and records reviewed the above allegations are found to be Unsubstantiated. A finding of unsubstantiated means although the allegations 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 where this report was discussed and a copy of the report with appeal rights were provided to Monique Del Junco 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: 04/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2023

LIC9099 (FAS) - (06/04)

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