366401304-12-5-2023-18-AS-EMAN-CY8UVM-20231205145518

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366401304
Report Date: 12/05/2023
Date Signed: 12/05/2023 09:41:50 AM

Substantiated

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
02/18/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220218081830

FACILITY NAME:	MARIA VICTORIA'S HOME CARE -A		FACILITY NUMBER:	366401304
ADMINISTRATOR:	CACHAPERO, HENRY		FACILITY TYPE:	740
ADDRESS:	11523 PEMBROKE STREET		TELEPHONE:	(909) 799-1537
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92350
CAPACITY:	6	CENSUS: 3	DATE:	12/05/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Henry Cachapero- Administrator		TIME COMPLETED:	09:52 AM

ALLEGATION(S):

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Conduct inimical.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to deliver findings for the above complaint allegation. LPA met with Administrator Henry Cachapero and explained the reason for the visit.

For allegation, Conduct inimical:

During investigation, it was revealed that Licensee Melita Cachapero engaged in conduct inimical to residents in care. It was found that sometime between January 1, 2015, and April 27, 2018, licensee violated Penal Code (PC) PC549-M: Solicit/Etc Bus Through False/Etc Insurance. Licensee was arrested, charged, and subsequently pled guilty to this charge on May 11, 2023. Following plea, Licensee was convicted, sentenced to county jail, and probation. Prior to January 1, 2015, and after April 27, 2018, licensee operated facility with residents in care.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

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 18-AS-20220218081830

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: MARIA VICTORIA'S HOME CARE -A	FACILITY NUMBER: 366401304
	VISIT DATE: 12/05/2023

NARRATIVE

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It was further determined that Licensee’s conduct violated at least one prior resident’s personal rights to be accorded safe, healthful, and comfortable accommodations. Licensee received payment of $1,400 for illegal hospice referral of at least one resident receiving hospice care. This conduct posed an immediate risk to residents in care.

Based on the evidence gathered during the investigation, the allegation listed above is deemed SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because of the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D form were discussed and provided to Administrator Henry Cachapero, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20220218081830

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: MARIA VICTORIA'S HOME CARE -A	FACILITY NUMBER: 366401304
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/05/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 12/06/2023 Section Cited CCR 87468.1	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.	1 2 3 4 5 6 7	The licensee has agreed to read regulation 87468.1 entirely and send LPA self-certified letter that the regulation was read and understood. POC is due by 12/6/2023.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Based on interview and document review, the licensee failed to ensure that at least one resident was accorded safe, healthful, and comfortable accommodations. Licensee received payment of $1,400 for illegal referral of at least one resident receiving hospice care which poses an immediate health, safety, or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2023

LIC9099 (FAS) - (06/04)

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