361881195-9-6-2023-56-AS-NBRN-CVVVVN-20230921164634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881195
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:17:12 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
08/28/2023 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230828144225

FACILITY NAME:	PALM VIEW PLEASANT LIVING		FACILITY NUMBER:	361881195
ADMINISTRATOR:	KARA RICHARDSON		FACILITY TYPE:	740
ADDRESS:	710 N CHURCH STREET		TELEPHONE:	(909) 328-2118
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	20	CENSUS: 18	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Elizabeth Mahan - Administrator		TIME COMPLETED:	01:19 PM

ALLEGATION(S):

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Staff are retaliating against resident for filing a complaint.
Staff inappropriately injected resident with an unprescribed medication.
Staff did not ensure resident was showered.
Staff are not treating resident with dignity.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate the above mentioned complaint allegations and deliver findings. LPA identified herself to facility staff who phoned administrator Elizabeth Mahan and were notified of the reason for today’s visit. Administrator Mahan arrived and LPA informed Mahan of the elements of the allegation. The investigation included resident and staff interviews, facility inspection, and records review.

Allegation 1: Facility staff are retaliating against Resident (R1) for filing a complaint. Interview with R1 deny that staff are retaliating against them but stated that some staff are not kind. Staff interviews reveal that all residents are treated with dignity and respect. Staff interviews further reveal that they work with more challenging residents and provide assistance to the resident's families.

Allegation 2: Staff inappropriately injected resident with an unprescribed medication. Interview with R1 denied that they received an injection from facility staff, but rather a nurse. Interviews with staff confirm that R1 is not receiving home health or hospice services who may administer injectable medication. LPA inspected R1 files and medication records and did not find any injectable medication and verified that R1 is not receiving outside services.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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-20230828144225

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: PALM VIEW PLEASANT LIVING	FACILITY NUMBER: 361881195
	VISIT DATE: 09/06/2023

NARRATIVE

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Allegation 3: Staff did not ensure resident was showered. LPA reviewed records showing that the facility maintains a resident shower schedule. LPA interviewed R1 who stated that sometimes they may receive one of two showers due to availability of staff. Interviews with other residents revealed that they are consistently receiving their showers.

Allegation 4: Staff are not treating R1 with dignity. LPA reviewed records showing that R1 has cognitive impairment. Interview with R1 revealed that some staff are not as pleasant as others. LPA interviewed several residents who stated that staff do not use inappropriate language towards them or other staff. Interviews with Staff 1 and Staff 2 deny using inappropriate language with residents or witnessing other staff verbally abuse any resident.

Based on the information obtained during this investigation, findings for the allegations are UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove alleged violations did or did not occur. An exit interview was conducted with Administrator Mahan and a copy of this report was provided.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

LIC9099 (FAS) - (06/04)

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