365530007-6-14-2023-56-AS-NBRN-CT3MYW-20230623100212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530007
Report Date: 06/14/2023
Date Signed: 06/14/2023 10:17:21 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
05/17/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230517081536

FACILITY NAME:	TRES MARIAS HOME CARE LLC		FACILITY NUMBER:	365530007
ADMINISTRATOR:	ALORO, MARIA NENITA N.		FACILITY TYPE:	740
ADDRESS:	749 W WINCHESTER DR.		TELEPHONE:	(909) 874-4712
CITY:	RIALTO	STATE: CA	ZIP CODE:	92376
CAPACITY:	6	CENSUS: 5	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maria Aloro, Administrator		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident sustained pressure injuries due to staff neglect.
Staff are mismanaging resident's medication.
Unqualified staff caring for residents.
Staff are not able to effectively communicate with residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Tres Marias Home Care facility unannounced to deliver the findings of the complaint. LPA was greeted by Administrator, Maria Aloro. LPA signed in and was provided a space to work.

It is alleged that a resident in care sustained a pressure injury due to staff neglect. Interview with the hospice agency revealed denial that residents in care are neglected. The hospice agency provides staff and family training on how to provide care according to residents’ needs. Staff and the Hospice agency deny that the residents in care are neglected in any way. Additionally, LPA reviewed medical records and progress notes of both hospice and the facility itself. No records indicated or showed evidence of neglect. Records were consistent with information collected in the interviews.

Please see LIC9099-C

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: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

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-20230517081536

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: TRES MARIAS HOME CARE LLC	FACILITY NUMBER: 365530007
	VISIT DATE: 06/14/2023

NARRATIVE

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It is alleged that staff are mismanaging residents’ medications. LPA reviewed resident’s Medication Administration Records along with the Centrally Stored Medications List. There was no evidence that medications had been missed. The documents were consistent with one another. Staff and Hospice Agency both deny having any problems with medication management. According the Adult and Senior Duty Logs, there have been no recent incident reports of medication errors from the facility.

It is alleged that unqualified staff are caring for residents. LPA conducted a record review of seven (7) staff files. 7 out of 7 staff files included proof of training which meets regulation. All staff members are provided their training upon their hire date and annually afterwards. On 5/26/22, the facility was approved to care for six (6) hospice residents.

It is alleged that staff are not able to effectively communicate with residents. During the visit, LPA communicated with Maria and number of staff members present. LPA had no difficulty communicating with staff to make requests or obtain records. LPA observed staff communicate with residents in care with no difficulty. LPA also observed staff communicating with one another with no difficulty. Staff all deny that they have had any trouble communicating with residents in care.

Based on observations, record reviews and interviews, 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 with facility representative and a copy of this report was provided.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 06/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2023

LIC9099 (FAS) - (06/04)

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