366413072-10-23-2020-18-AS-EMAN-BV3S6B-20201105123540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 10/23/2020
Date Signed: 10/23/2020 03:43:29 PM

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
05/28/2020 and conducted by Evaluator Robbie Johnson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200528112653

FACILITY NAME:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	366413072
ADMINISTRATOR:	TOMI MORALES		FACILITY TYPE:	740
ADDRESS:	2985 NORTH G STREET		TELEPHONE:	(909) 883-7703
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	97	CENSUS: 65	DATE:	10/23/2020
		UNANNOUNCED	TIME BEGAN:	02:52 PM
MET WITH:	Shannon Johnson, Executive Director		TIME COMPLETED:	03:53 PM

ALLEGATION(S):

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Facility staff failed to seek appropriate medical care for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Robbie Johnson contacted the facility via telephone to deliver findings regarding the above allegation via telephone due to COVID-19. LPA identified herself and discussed the purpose of the call and the elements of the above allegation with Executive Director Shannon Johnson.

The Department conducted investigation of allegation to include interviews and records review. Interviews revealed that resident R1 complained to facility staff about vaginal discomfort. A review of facility records revealed that staff completed an assessment on R1 and contacted R1's physician for further direction. A review of R1's medical records revealed that R1 was prescribed medication. A review of the facility Medication and Administration records revealed that R1 was administered medications per physicians orders. Interviews with staff revealed that R1 had no further complaints about vaginal discomfort once medication was given. LPA could find no evidence to support that the facility failed to seek appropriate medical care for R1. The allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred. A copy of this report was reviewed with and provided to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Robbie Johnson	TELEPHONE: (951) 248-0304
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020

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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