361881136-2-14-2024-56-AS-EMAN-D2NSF8-20240221124955

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881136
Report Date: 02/14/2024
Date Signed: 02/14/2024 03:23:38 PM

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
01/31/2024 and conducted by Evaluator Melody Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240131113726

FACILITY NAME:	WAGONWHEEL RESIDENTIAL CARE		FACILITY NUMBER:	361881136
ADMINISTRATOR:	CYNTHIA Y. JONES		FACILITY TYPE:	735
ADDRESS:	5648 WAGONWHEEL RD		TELEPHONE:	(909) 319-1834
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	4	CENSUS: 2	DATE:	02/14/2024
		ANNOUNCED	TIME BEGAN:	02:50 PM
MET WITH:	Administrator/House Manager Antoinette Hill		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff inappropriately physically restrained resident.
Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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On 02/14/2024 at 02:50 PM, Licensing Program Analyst (LPA) Melody Brown met with Administrator/House Manager Antoinette Hill at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegations. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews, and a review of pertinent documentation.

The investigation was conducted by LPA Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates Staff inappropriately physically restrained resident.
During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with 4 of 4 staff indicated that no staff at the facility inappropriately physically restrained residents. Staff #2 (S2) revealed to LPA Brown that S2 was not familiar with appropriate terminologies or words to use on electronic mail and S2 reported that no staff at the facility inappropriately physically restrained Client #1 (C1).
*** Continuation in LIC9099C ***

Unsubstantiated

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: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

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-20240131113726

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: WAGONWHEEL RESIDENTIAL CARE	FACILITY NUMBER: 361881136
	VISIT DATE: 02/14/2024

NARRATIVE

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Interview with C1 indicated that staff at the facility held C1's hand for them to be able to cut C1's nails and for C1 not to be nervous. Also, C1 did not report that staff inappropriately physically restrained C1. LPA Brown unable to interview C2 as C2 unable to answer LPA Brown's questions.

The second allegation indicates Staff handled resident in a rough manner. Interviews with 4 of 4 staff indicated that staff at the facility are not handling residents in a rough manner. Staff interviews revealed that they are prompting and redirecting their clients at the facility, but no incident happened at the facility where a staff handled resident in a rough manner. S2 reported to LPA Brown that S2 used inappropriate and incorrect words or terminologies on S2's Care Notes and S2 emphasized that no staff at the facility's handling resident in a rough manner. Moreover, S2 revealed to LPA Brown that S2 was not thought on how to correctly write Care Notes that's why errors were made. Interview with C1 did not indicate that staff at the facility are handling C1 in a rough manner. C1 reported to LPA Brown that S3 grabbed C1's arm after informing C1 that they will go out for a walk but S3 did not hurt C1's arm. LPA Brown unable to interview C2 as C2 unable to answer LPA Brown's questions. Also, during the facility visit on 02/07/2024, LPA Brown observed staff providing care and supervision to C1 and LPA Brown did not see any staff handling C1 in a rough manner.

Based on the evidence, the allegations that Staff inappropriately physically restrained resident (Allegation #1), and Staff handled resident in a rough manner (Allegation #2) 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.

An exit interview was conducted where this report, LIC9099, was discussed and provided to Administrator/House Manager Antoinette Hill.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024

LIC9099 (FAS) - (06/04)

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