366412345-7-3-2023-56-AS-EMAN-CUWQ9C-20230821115807

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366412345
Report Date: 07/03/2023
Date Signed: 07/03/2023 12:03:54 PM

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
06/29/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230629093929

FACILITY NAME:	JUBILEE CARE HOMES		FACILITY NUMBER:	366412345
ADMINISTRATOR:	HERNANDEZ, NORMA		FACILITY TYPE:	735
ADDRESS:	1066 WINN DR		TELEPHONE:	(909) 755-1178
CITY:	UPLAND	STATE: CA	ZIP CODE:	91786
CAPACITY:	6	CENSUS: 4	DATE:	07/03/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Soliman Co		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff make inappropriate comments toward clients
Staff do not assist clients with showering
Staff are sleeping in client's beds

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility to investigate and deliver findings for the above complaint allegation. LPA met with Administrator Oliver Dineros and explained the purpose for the visit. The visit consisted of interviews, document review, and a facility tour.

For allegation, Staff make inappropriate comments toward clients.

During interviews with clients, the client’s stated the staff does not make inappropriate comments towards clients.C1 informed LPA that C2 makes inappropriate comments towards C1.

During interviews with staff, the staff stated they have not made any inappropriate comments towards clients The Administrator informed LPA that C2 has made inappropriate comments to C1. In addition, S1 and S2 also informed LPA that they have witness C2 make inappropriate comments to C1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

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 2

Control Number 56-AS-20230629093929

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: JUBILEE CARE HOMES	FACILITY NUMBER: 366412345
	VISIT DATE: 07/03/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

For allegation, Staff do not assist clients with showering.

During interviews with clients, the client’s stated the staff assist them with their showers. C1 had informed LPA that the staff assist them with their showers due to (R) leg injury but before their injury they would shower everyday by themselves. C2 informed LPA they are independent with showers, but also informed LPA that C1 room smells like urine. C3 and C4 informed LPA that the staff showers them every morning.

During interviews with staff, the staff stated they provide showers to their clients. S1 informed LPA they shower their clients every day before breakfast. Administrator informed LPA that C1 would refuse assistance with their showers, but due to C1 recent leg injury C1 has allowed staff to assist with their showers.

During document review, LPA obtained consumer daily activity schedule, clients notes, and four(4) client's program plan..

Furthermore, S1 gave LPA a tour of the facility. During the tour LPA observed a strong odor of urine from C1 room. C1 was present and had informed LPA they refuse for their room to be cleaned. In addition, C1 stated they will allow staff to clean their room for the odor to leave.

For allegation, staff are sleeping in client’s beds.

During interviews with clients, the client’s stated they have not seen staff sleep in their beds. C2 informed LPA that staff have their own room by the kitchen where they can sleep.

During interviews with staff, staff stated they have not slept in client’s room.

In addition, during facility tour. LPA observed a bed in staff room.

Based on the evidence found during the investigation, the three (3) allegations listed above is deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Care Giver Soliman Co, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2