361881134-6-27-2024-56-AS-EMAN-D7ART6-20240718131750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881134
Report Date: 06/27/2024
Date Signed: 06/27/2024 11:44:02 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/21/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240621151145

FACILITY NAME:	ALLARA SENIOR LIVING		FACILITY NUMBER:	361881134
ADMINISTRATOR:	HEFNER, LEEANN		FACILITY TYPE:	740
ADDRESS:	9417 19TH STREET		TELEPHONE:	(909) 736-1900
CITY:	RANCHO CUCAMONGA	STATE: CA	ZIP CODE:	91701
CAPACITY:	120	CENSUS: 90	DATE:	06/27/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director Patricia Gustin		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff did not provide resident's records to authorized representative.

INVESTIGATION FINDINGS:

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On 06/27/2024 at 09:30 AM, Licensing Program Analyst (LPA) Melody Brown arrived unannounced at the facility to initiate and deliver findings for the mentioned allegation. LPA Brown was greeted and granted entry by a staff and LPA Brown met with Business Office Director Helen Jaquez. Executive Director (ED) Patricia Gustin was contacted and arrived during the visit. LPA Brown met with ED Gustin and LPA Brown informed ED Gustin of the purpose of the visit.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that Staff did not provide resident's records to authorized representative. LPA Brown obtained evidence to corroborate the allegation above. Interviews with Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) all indicated that they submitted the documents requested to their legal department. S1 reported to LPA Brown that they submitted the complete file requested to their legal department on 06/19/2024. ***Continuation in LIC9099C***

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

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-20240621151145

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: ALLARA SENIOR LIVING	FACILITY NUMBER: 361881134
	VISIT DATE: 06/27/2024

NARRATIVE

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During this visit, S1 reported to LPA Brown that their Legal Department sent Resident #1 (R1) records to R1’s authorized representative on 06/21/2024. Per documents review and interviews conducted, R1’s authorized representative requested R1’s records on 06/06/2024 and the facility did not make the documents available to R1's authorized representative as required per Title 22 Division 6 Chapter 8 Article 8 Resident Assessments, Fundamental Services and Right 87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a)(19).

Based on LPA Brown’s observations and records review, the preponderance of evidence standard has been met, and therefore the above allegation of Staff did not provide resident's records to authorized representative is found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to Executive Director (ED) Patricia Gustin.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20240621151145

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: ALLARA SENIOR LIVING	FACILITY NUMBER: 361881134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 06/27/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/08/2024 Section Cited CCR 87468.2(a)(19)	1 2 3 4 5 6 7	87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have.. (19) To 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... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated to train all staff on CCR 87468.2(a)(19) and submit proof of all staff training log to LPA Brown on Plan of Correction (POC) due date.
	8 9 10 11 12 13 14	Based on interview and records review, the Licensee did not comply with the section cited above by not providing Resident #1 (R1) records to R1 representative as required as evidenced of the facility provided R1's records to R1's Representative on 06/21/2024 which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC9099 (FAS) - (06/04)

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