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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366402567
Report Date: 12/22/2023
Date Signed: 12/22/2023 12:03:53 PM

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
12/21/2023 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231221113756
FACILITY NAME:INLAND ADULT DEVELOPMENTAL CENTERFACILITY NUMBER:
366402567
ADMINISTRATOR:DORIS EKANEMFACILITY TYPE:
775
ADDRESS:10221-B TRADEMARK STREETTELEPHONE:
(909) 483-1310
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:45CENSUS: 33DATE:
12/22/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Djarnette Green, Program DirectorTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Facility faucets used by clients for personal care do not deliver hot water.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannounced complaint visit to the facility. LPA met with Djarnette Green, Program Director, and discussed the purpose of the visit.
Regarding the allegation, facility faucets used by clients for personal care do not deliver hot water, the Program Director stated that the facility has not had hot water since 12/13/23. On 12/14/23, a service maintenance was conducted; however maintenance was not able to fix the water temperature due a possible hot water heater issue which requires property management assistance. On 12/21/23, The Program Director stated that their business manager was going to email property management as facility still has no hot water. LPA tested the hot water in (3) handwashing facilities, which tested at no higher that 69 degrees F.
Based on LPA observations, interviews, and document review, the allegation is Substantiated. A substantiated finding means that the preponderance of evidence standard has been met. A deficiency is being cited in accordance with California Code of Regulations.
An exit interview was conducted where reports LIC9099/LIC9099-D were discussed and copies with Appeal Rights were provided to the Program Manager at the conclusion of the visit.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20231221113756
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: INLAND ADULT DEVELOPMENTAL CENTER
FACILITY NUMBER: 366402567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/28/2023
Section Cited
CCR
82088(e)(1)
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82088 Fixtures, Furniture, Equipment...(e)Faucets used by clients for personal care shall deliver hot water. (1) Hot water temperature controls shall be maintained to...attain a hot water temperature of not less than 105 degrees F (40.5 degrees C); this requirement is not met as evidenced by:
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Licensee/Program Director shall submit to the Licensing Agency by POC due date proof that maintenance has been completed and hot water temperatures are per California Code of Regulations
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The Licensee did not comply with section cited by hot water in client handwashing facilities tested below regulation standards; which is a potential health, safety, or personal rights risks to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 12/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3