366402896-10-30-2023-56-AS-NBRN-CX5R3F-20231031123948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366402896
Report Date: 10/30/2023
Date Signed: 10/30/2023 02:11:09 PM

Unfounded

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
10/04/2023 and conducted by Evaluator Amber Coleman

COMPLAINT CONTROL NUMBER: 56-AS-20231004142529

FACILITY NAME:	GENESIS MANOR		FACILITY NUMBER:	366402896
ADMINISTRATOR:	GERRY MARKIE		FACILITY TYPE:	740
ADDRESS:	6354 SACRAMENTO AVE		TELEPHONE:	(909) 262-9802
CITY:	ALTA LOMA	STATE: CA	ZIP CODE:	91701
CAPACITY:	6	CENSUS: 6	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Josephine Sandigan, Caregiver		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Uncleared staff members are allowed to work in the facility.
Facility does not have a qualified Administrator.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Gensis Manor, Residential Care Facility for the Eldery to deliver the findings of the complaint investigation into the allegations listed above. LPA met with staff member, Josephine Sandigan, who contacted the facility's Administrator, Marya Alpert to notify her of LPA's visit. LPA introduced self and stated the purpose of the visit.

It is alleged that uncleared staff member are allowed to work in the facility. LPA reviewed the facility's staff records. All staff files contained criminal statements and fingerprint clearence records. Also, all staff files included proof of up to date training and verifications per regulation. LPA reaserched the Department's Guardian website, which used to keep track of staff criminal record clearences and associations. LPA located and verified that all staff members associated to the facility along with their clearences for fingerprints and criminal records. All of which in good standing. This was also consistent with the facility's current staff roster,

Please see LIC9099-C

Unfounded

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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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 4

Control Number 56-AS-20231004142529

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: GENESIS MANOR	FACILITY NUMBER: 366402896
	VISIT DATE: 10/30/2023

NARRATIVE

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It is alleged that the facility does not have a qualified Administrator. LPA reviewed staff files and located two Administrators listed for the facility. Both Administrator Certificates were up to date. Using the Administrator Certificate Numbers, LPA researched the Community Care Licensing, Administrator Certificate website. LPA located both Administrators by certificate numbers and found both certificates were current and in good standing. LPA did not to locate any evidence that either of the listed Administrator Certificates was ever lapsed or in question.

Based on observations and record reviews, We have found the complaint allegation(s) is/ are unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed with, and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
10/04/2023 and conducted by Evaluator Amber Coleman

COMPLAINT CONTROL NUMBER: 56-AS-20231004142529

FACILITY NAME:	GENESIS MANOR		FACILITY NUMBER:	366402896
ADMINISTRATOR:	GERRY MARKIE		FACILITY TYPE:	740
ADDRESS:	6354 SACRAMENTO AVE		TELEPHONE:	(909) 262-9802
CITY:	ALTA LOMA	STATE: CA	ZIP CODE:	91701
CAPACITY:	6	CENSUS:	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Josephine Sandigan, Caregiver		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff prevented home health agency staff from performing their duties.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Genesis Manor, Residential Care Facility for the Elderly unannounced to deliver the findings of the complaint investigation into the allegations listed above. LPA met with Josephine Sandigan, Caregiver who granted LPA entry. LPA introduced self and stated purpose of the visit. Josephine contacted Administrator, Marya Alpert to notify of LPA visit. LPA spoke with Administrator and stated the purpose of the visit.

LPA interviewed staff, collected and reviewed pertinent documents and walked through the facility. LPA determined that there were no concerns for the residents' care and supervision at the time of visit.
It is alleged that staff prevented home health agency staff from performing their duties. During staff interviews, it was discovered that there is an ongoing tiff between the residents in care, the home health agency and staff. Staff and the families of residents in care have expressed that they no longer wish to continue services with the home health agency. The home health agency refuses to discharge the residents from the services. 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: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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 56-AS-20231004142529

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: GENESIS MANOR	FACILITY NUMBER: 366402896
	VISIT DATE: 10/30/2023

NARRATIVE

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Because the home health agency is refusing to discharge the residents from their care, it poses an issue with residents attempting to sign up for services with alternate home health agencies.

Based on the information above, 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. No deficiencies cited at this time. An exit interview was conducted where this report (LIC9099 & LIC9099C) was discussed, and a copy of this report was provided to Facility Representatives at the conclusion of the visit.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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