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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366412345
Report Date: 10/02/2023
Date Signed: 10/02/2023 10:13:26 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
08/28/2023 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230828092445
FACILITY NAME:JUBILEE CARE HOMESFACILITY NUMBER:
366412345
ADMINISTRATOR:HERNANDEZ, NORMAFACILITY TYPE:
735
ADDRESS:1066 WINN DRTELEPHONE:
(909) 755-1178
CITY:UPLANDSTATE: CAZIP CODE:
91786
CAPACITY:6CENSUS: 3DATE:
10/02/2023
UNANNOUNCEDTIME BEGAN:
09:57 AM
MET WITH:Oliver Dineros TIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Illegal eviction
Staff do not ensure medications are dispensed as prescribed
Staff do not ensure clients are spoken to in an appropriate manner
Staff do not ensure clients receive bathing assistance
Staff do not ensure facility is kept free of malodors
Staff do not ensure provision of care is provided to meet clients needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Facility Administrator Oliver Dineros and explained the purpose of the visit. The investigation consisted of interviews and a review of records.

First allegation, Illegal eviction. During record review and interview with Staff #2 (S2), stated that Client #1 (C1), was not illegally evicted. Staff #2 stated that a 30-day was issued for Client #1 upon client’s request. During interview with Client #1 authorized representative, stated that a 30-day notice was received by Staff #1 upon client #1 request authorized representative stated that client #1 did not get illegally evicted by Facility and that a meeting was held regarding client #1 30-day notice.

Second allegation, Staff do not ensure medications are dispensed as prescribed. LPA conducted a record review of all clients’ medications being dispensed. LPA observed that all medications are being dispensed accordingly and based on physician’s orders. During interviews with Staff #2 and Staff #3 both stated that all medications are dispensed at a set time for all residents as prescribed.

Third allegation, Staff do not ensure clients are spoken to in an appropriate manner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
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-20230828092445
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: 10/02/2023
NARRATIVE
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During interview with Client #2, Client #3, and Client #4 all stated that staff are respectful and speak to them in an appropriate manner. LPA asked Client #2, Client# 3, and Client # 4 if they have witnessed staff speak to other clients in an inappropriate manner all stated “No”.

Fourth allegation, Staff do not ensure clients receive bathing assistance. During interviews with Client #2, Client #3, and Client #4 all stated the staff assist them with their showers. Client #2 informed LPA that the staff assist C#2 with showers and diaper change C#2 indicated to LPA that at times C#2 does not like to shower however, has been making improvement according to C#2 IPP goals. Client #2, Client #3, and Client #4 all stated that minimal supervision is needed with showers, and that showers are every morning or during the night.

Fifth allegation, Staff do not ensure facility is kept free of malodors. LPA conducted a room inspection in Room #1, Room #2 (vacant), Room #3, and Room #4 and observed rooms to be clean and free of malodors. LPA inspected facility bathroom and observed client’s restroom to be clean and free of malodors. LPA conducted an overall inspection of the facility and observed facility to be clean and free of malodors.

Sixth allegation, Staff do not ensure provision of care is provided to meet client’s needs. During interviews with Client #2, Client #3, and Client #4 all stated that facility staff ensures that their daily needs along with care is always met. Client #2 stated that at times showers and diaper change can be a struggle as that is part of Client #2 behavior however, Client #2 stated that improvement has been made and staff helps Client #2 with redirection. 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 Oliver Dineros at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 10/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2