366412250-4-4-2024-56-AS-EMAN-D49TRG-20240412145729

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366412250
Report Date: 04/04/2024
Date Signed: 04/04/2024 10:24:48 AM

Unsubstantiated

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
03/27/2024 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240327104326

FACILITY NAME:	DIVINE HOME CARE		FACILITY NUMBER:	366412250
ADMINISTRATOR:	SWANSON, MARY EILEEN		FACILITY TYPE:	740
ADDRESS:	25937 LAWTON AVE		TELEPHONE:	(909) 796-2783
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	6	CENSUS: 5	DATE:	04/04/2024
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Mary Eileen Swanson		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff verbally abusing resident in care
Staff not providing nutritious food to resident in care
Staff did not ensure medical services are provided to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Mary Eileen Swanson and explained the purpose of the visit. The investigation consisted of interviews and review of records.

First allegation, Staff verbally abusing resident in care. During the investigation and staff file review it was revealed that the alleged resident listed in the complaint was a staff member and not a resident in care. LPA conducted interviews with resident’s who stated that they are not being verbally abused by staff or have witnessed staff verbally abuse other residents in care.

Second allegation, Staff not providing nutritious food to resident in care. During the investigation and staff file review it was revealed that the alleged resident listed in the complaint was a staff member and not a resident in care. LPA conducted interview with residents who stated that they have no concerns regarding the food and stated that the facility provides them with good and well balance meals.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

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-20240327104326

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: DIVINE HOME CARE	FACILITY NUMBER: 366412250
	VISIT DATE: 04/04/2024

NARRATIVE

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LPA conducted food inspection LPA observed adequate amount of perishable and nonperishable food supply that meets the number of residents in care. In addition, food supply appeared to be adequate to date.

Third allegation, Staff did not ensure medical services are provided to resident in care. During the investigation and staff file review it was revealed that the alleged resident listed in the complaint was a staff member and not a resident in care. LPA conducted interviews with residents in care and residents indicated to LPA that facility provides medical services when medical assistance is needed or required. Residents stated to LPA that they have no concerns regarding medical services. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Mary Eileen Swanson at the end of the visit.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 04/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2024

LIC9099 (FAS) - (06/04)

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