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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881134
Report Date: 06/10/2024
Date Signed: 06/10/2024 11:52:45 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
06/06/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240606103223
FACILITY NAME:ALLARA SENIOR LIVINGFACILITY NUMBER:
361881134
ADMINISTRATOR:HEFNER, LEEANNFACILITY TYPE:
740
ADDRESS:9417 19TH STREETTELEPHONE:
(909) 736-1900
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91701
CAPACITY:120CENSUS: 92DATE:
06/10/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Patricia Gustin, Executive DirectorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Resident sustained an unexplained injury while in care
Staff did not provide adequate care and supervision to a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto met with Executive Director Patricia Gustin and explained the elements of the complaint.

Regarding the allegation that resident sustained an unexplained injury while in care; Staff #1 (S1) interview reveal that resident #1 (R1), in question, was dressed in the AM and did not observe any injuries to R1 during S1's shift. Interview with staff #2 (S2) revealed the R1 is on blood thinners and is susceptible to bruising, but S2 did not observe any injuries to R1. R1 resided at the facility for approximately 31 hours and was not available for interview or observation for any injuries or the care received at the facility.
***continued on LIC 9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
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 2
Control Number 56-AS-20240606103223
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: 06/10/2024
NARRATIVE
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Interview with staff #3 (S3) states that hourly checks were conducted with R1 as all new resident are. S3 stated that R1 was assisted by S3 with eating. S3 stated that R1 had no injuries throughout the day, but did observe a small bruise on R1's leg when 911 was called to attend to R1 on an unrelated medical matter. S3 stated bruise was not on R1's person throughout the day.

Regarding the allegation that staff did not provide adequate care and supervision to a resident; Staff interviews reveal the R1 was dressed by two (2) staff members, assisted with feeding and seen by the med tech staff in the short time R1 resided at the facility. Staff called 911 services for R1 and medical staff were present at that facility to address R1's needs right away.

Based on the information obtained there is not enough evidence that resident sustained an unexplained injury while in care and staff did not provide adequate care and supervision to a resident . Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Gustin and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2024
LIC9099 (FAS) - (06/04)
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