361881134-8-15-2023-56-AS-NBRN-CUTLVR-20230818090559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881134
Report Date: 08/15/2023
Date Signed: 08/15/2023 11:51:26 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/10/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230810143801

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: 71	DATE:	08/15/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Ted Burgess, Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in a resident sustaining an unexplained injury.
Staff did not properly report an incident involving a resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Allara Senior Living Facility to initiate a complaint investigation into the allegations listed above. LPA introduced self an stated purpose of the visit. LPA was introduced to Ted Burgess, Administrator. LPA informed Administrator of the purpose of the visit and discussed elements of the allegations. During today's visit, LPA completed a walk through the facility, collected and reviewed documents, interviewed staff, residents and hospice agency staff.

It is alleged that staff did not provide adequate supervision resulting in a resident sustaining an unexplained injury. The facility conducted an investigation of their own; all staff involved in the resident's care deny observing the bruise or having any knowledge of how or when it occurred. The hypothesis is that the resident may have inadvertently bruised themselves while having a behavioral episode. Staff schedule revealed that there are two or more caregivers on the resident's floor during the day and evenings - which is adequate for the number of residents in care. The facility cares for residents who suffer memory impairment; and housed in a secure environment.
Please see LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

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-20230810143801

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALLARA SENIOR LIVING	FACILITY NUMBER: 361881134
	VISIT DATE: 08/15/2023

NARRATIVE

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The facility does not provide one on one supervision for residents in care. For additional care, residents/family are welcomed to contract additional services via healthcare agencies. During interviews with the hospice agency, it was reported that the hospice agency has no concerns about the care being provided to the residents at this time. The Hospice Agency provides facility staff with regular in-service classes. Last class was held on June 16th, 2023.

It is alleged that staff did not properly report an incident involving a resident while in care. Interviews with the Hospice Agency revealed that the assigned home health aide observed a bruise on a resident Sunday, August 6th, 2023. The home health aide reported to her supervisor the following date - Monday, August, 7th, 2023. The Hospice Supervisor reported the bruise to the facility the same date 8/7/23. Community Care Licensing Duty Logs - show that the facility submitted a Special Incident Report on 8/9/23 reporting that a bruise was observed on a resident in care. The cause or origin of the bruise was unknown. Staff interviews revealed that the bruise was observed and reported on 8/9/23. The incident was reported to Community Care Licensing within the regulated time frame.

Based on interviews, observations and record reviews; these allegations are UNSUBSTANTIATED. A finding of 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.

An exit interview was conducted where this report was reviewed, discussed then provided to Facility Representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2023

LIC9099 (FAS) - (06/04)

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