366413072-7-25-2024-56-AS-KCLS-D8449Z-20240812185506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 07/25/2024
Date Signed: 07/25/2024 02:51:21 PM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/19/2024 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20240719162559

FACILITY NAME:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	366413072
ADMINISTRATOR:	CARLTON, KENYA		FACILITY TYPE:	740
ADDRESS:	2985 NORTH G STREET		TELEPHONE:	(909) 883-7703
CITY:	SAN BERNARDINO	STATE: CA	ZIP CODE:	92405
CAPACITY:	97	CENSUS: 84	DATE:	07/25/2024
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Kenya Carlton-Administrator		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Staff not dispensing medications as prescribed
Staff not assisting residents with medication refills

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to commence a complaint investigation and deliver findings. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Kenya Carlton, Administrator.

The investigation consisted of interviews with staff, residents and record review. LPA reviewed five (5) residents files R1, R2, R3, R4 and R5 according to the facility's Medication Administration Record (MARS) revealed that all medications were given to the residents as prescribed by their physician. There is no evidence showing that medication was missed or not noted. LPA also interviewed two (2) staff members who stated most residents’ medications are on automatic refill and those who are not on auto refill their responsible parties are notified of refill prescriptions 7-10days before required. If there is no responsible party for the resident staff members are responsible for calling the pharmacy 7-10days prior to the prescriptions being required.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

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-20240719162559

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: VILLAS AT SAN BERNARDINO	FACILITY NUMBER: 366413072
	VISIT DATE: 07/25/2024

NARRATIVE

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Staff has also confirmed there is protocol in place to get emergency prescriptions as needed for any resident in their facility and while at the facility verbal confirmation from pharmacy staff confirmed that emergency prescriptions are filled as needed for residents in care.

LPA Allen also interviewed two (2) residents who stated that their medications are given to them as prescribed by their physicians.

Based on the investigation interviews, documentation, and observations the above findings are Unsubstantiated. A finding of unsubstantiated means although the allegations 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, and a copy was provided to Kenya Carlton at the conclusion of the visit with the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 07/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/25/2024

LIC9099 (FAS) - (06/04)

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