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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366402735
Report Date: 05/05/2021
Date Signed: 05/21/2021 08:38:51 AM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2020 and conducted by Evaluator Pauline Beschorner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201006144441
FACILITY NAME:RAMADA RANCHFACILITY NUMBER:
366402735
ADMINISTRATOR:EMERSON, DIANE L.FACILITY TYPE:
740
ADDRESS:35859 RAMADA LANETELEPHONE:
(909) 797-7822
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:6CENSUS: 5DATE:
05/05/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Diane EmersonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has mold
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Licensee/Administrator Diane Emerson.

The allegation alleges the facility has mold. During the initial FaceTime phone call with Emerson on October 7, 2020, LPA observed what appeared to be discoloration above the base board in bathroom 2. LPA is unable to corroborate if the discoloration is mold or dirt.
This agency has investigated the above-mentioned complaint allegation. Although the above-mentioned allegations may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegation is deemed UNSUBSTANTIATED at this time.

CONTINUED ON NEXT PAGE
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
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 4
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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2020 and conducted by Evaluator Pauline Beschorner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201006144441

FACILITY NAME:RAMADA RANCHFACILITY NUMBER:
366402735
ADMINISTRATOR:EMERSON, DIANE L.FACILITY TYPE:
740
ADDRESS:35859 RAMADA LANETELEPHONE:
(909) 797-7822
CITY:YUCAIPASTATE: CAZIP CODE:
92399
CAPACITY:6CENSUS: 5DATE:
05/05/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Diane EmersonTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Walkway is in disrepair
Bathroom is in disrepair
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Licensee/Administrator Diane Emerson.

The first allegation alleges the walkway is in disrepair. LPA observed the walkway in the back yard was cracked and buckled due to tree roots. Licensee stated when she noticed the walkway cracked and buckled in October 2020, she immediately placed large orange cones around the broken walkway. LPA interviewed staff and interviews revealed the residents do not like to go outside on a regular basis and this sidewalk is not used for emergency evacuation purposes. When there are residents who do decide to go outside the resident is always supervised to ensure the safety of the resident. Due to the cost of replacing the walkway the repair will be scheduled at a future date.

CONTINUED ON NEXT PAGE
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20201006144441
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
RIVERSIDE, CA 92507
FACILITY NAME: RAMADA RANCH
FACILITY NUMBER: 366402735
VISIT DATE: 05/05/2021
NARRATIVE
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The second allegation alleges the bathroom is in disrepair. During the initial FaceTime phone call with Licensee on October 7, 2020, LPA observed the bathroom to be in disrepair as there were missing tiles around the faucet, tiles were falling off the wall near the baseboard, and paint was chipping above the baseboard which appeared to be water damage. Licensee told LPA on January 23, 2020; Licensee called a plumber out to fix a leaky faucet. At that time there was a discussion with the plumber about a possible slow slab leak. At the end of January 2020, Licensee called for a second opinion on the slab leak. The plumber came in and conducted video surveillance and determined that there was not a slab leak. In June 2020, Licensee called out a carpet cleaning company to shampoo the master bedroom carpet as there was a slow leaky pipe. At that time the carpet was picked up to determine if there was mold under the carpet. The carpet cleaning company determined there was no mold detected. Between June 2020 and November 2020 Licensee noticed additional tiles falling off of the wall and more paint chipping away from the wall. On November 23, 2020, the contractor began to remodel/repair the hallway bathroom. At that time, the slow leaky pipe was discovered and repaired during the remodel. The repairs/remodel did not interrupt the care being provided to the residents as there was another bathroom available for resident use. The remodel/repairs were completed by December 3, 2020. LPA has observed that the water damage has been fixed. No hazards are present in the master bathroom. The master bathroom is still operable. The damage in the master bathroom is from the leaky pipe which was discovered in the middle bathroom and backs up to the hallway bathroom. The master bathroom will be fixed at a later date due to the cost of the repairs.

Based on LPA observations, interviews and review of documentation, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be SUBSTANTIATED. Although the allegation is substantiated, interviews and documentation revealed there was no impact to the clients as the disrepair's did not present any danger and did not affect the overall operation of the facility. This is considered a technical violation and no citation is being issued at this time.

An exit interview was conducted, and a copy of this report was reviewed and appeal rights were provided to Licensee Diane Emerson, whose signature on this form confirm receipt of the above-mentioned documents.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 18-AS-20201006144441
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
RIVERSIDE, CA 92507
FACILITY NAME: RAMADA RANCH
FACILITY NUMBER: 366402735
VISIT DATE: 05/05/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
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28
29
30
31
32
An exit interview was conducted, and a copy of this report was reviewed with and provided to Licensee/Administrator Diane Emerson, whose signature on this form confirm receipt of the above-mentioned documents.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4