365530010-5-9-2023-56-AS-KCLS-CRY5CE-20230518195012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530010
Report Date: 05/09/2023
Date Signed: 05/09/2023 11:20:11 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
05/03/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230503163537

FACILITY NAME:	SAN BERNARDINO SERENITY LIVING		FACILITY NUMBER:	365530010
ADMINISTRATOR:	MAGTOTO, EDWARD		FACILITY TYPE:	735
ADDRESS:	2414 OGDEN ST.		TELEPHONE:	(213) 618-0938
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92407
CAPACITY:	20	CENSUS: 19	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Glenda Remigio		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff is failing to provide resident's hygiene needs.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Bernadette Allen made an unannounced visit to the facility for the purpose of initiating and delivering findings on the complaint above. LPA met with Glenda Remigio caregiver who was informed of the purpose of my visit and the allegation.

LPA Allen conducted interviews with (3) three residents, (3) three outside parties and (2) two staff members. (R1) Resident 1 was not at the facility during the visit but was called (R1) agreed to be interviewed over the phone. The interviews conducted with the (3) three residents said that they are always allowed to shower daily and wash their cloths and that they didn’t have any concerns with their hygiene needs. The interviews with the (3) three outside parties said that there are concerns with (R1) hygiene needs and that (R1) is allowed to shower whenever they want but (R1) is not willing to address their hygiene needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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-20230503163537

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: SAN BERNARDINO SERENITY LIVING	FACILITY NUMBER: 365530010
	VISIT DATE: 05/09/2023

NARRATIVE

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The (2) two staff members on duty were also interviewed and stated that residents are allowed to shower as often as needed but they do have wash days for clothing. Staff members said that they never force residents to shower or to wash their cloths but are strongly encouraged. Documents were reviewed and the responsible parties and staff member are currently in the process of locating another facility to fit the needs of (R1).

Based on documents reviewed and interviews conducted with the outside parties, staff members and residents. The above allegation is Unsubstantiated. A finding of unsubstantiated means although the allegations 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 and discussed with Glenda Remigio and a copy was provided with appeals rights at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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