366413072-10-3-2023-56-AS-NBRN-CWNRFW-20231016125950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413072
Report Date: 10/03/2023
Date Signed: 10/03/2023 01:27:31 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
09/25/2023 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230925103052

FACILITY NAME:	VILLAS AT SAN BERNARDINO		FACILITY NUMBER:	366413072
ADMINISTRATOR:	YVETTE NAVARRO		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:	10/03/2023
		UNANNOUNCED	TIME BEGAN:	08:44 AM
MET WITH:	Kenya Carlton, Executive Director		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Facility not being maintained in good repair.
Facility not able to meet operational costs for care of residents.

INVESTIGATION FINDINGS:

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This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is to initiate the 10 day visit to investigate the above-mentioned complaint allegations. LPA met with Executive Director Kenya Carlton and disclosed the elements of the alleged violation.

During the course of the investigation, interviews were conducted with the Executive Director and eight (8) residents. LPA reviewed eight resident files and reviewed eight (8) residency agreements. LPA obtained a copy of the residency agreement and reviewed basic services provided in the contract. LPA toured the facility including stairwells and emergency evacuation routes. LPA assessed for signs of disrepair and elevator availability. LPA verified elevator maintenance contract through phone call to Schindler Elevator. LPA reviewed availability of food and hydration. Investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

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-20230925103052

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: 10/03/2023

NARRATIVE

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It is alleged that because the facility elevator is not working that the facility is in disrepair. Interview with Executive Director Kenya Carlton revealed that one of two elevators is currently broken down and a part is on back order. The facility is contracted with Schindler Elevator for repairs. During this visit a telephone call was made to the company Schindler Elevator and it was confirmed that the elevator was serviced on 09/24/2023 and that new parts are on order but delayed. The facility has two elevators. Executive Director Kenya Carlton admitted that there was a Maintenance Power Outage on 09/27/2023 placing both elevators inoperable. LPA was provided with notification dated 09/27/2023 from Southern California Edison confirming this claim. Residents on the second floor were provided with tray service and assisted down stairs if necessary as confirmed by eight (8) of eight (8) residents interviewed. LPA tour of physical plant revealed the facility has maintained emergency evacuation chairs at two (2) stairwells to assist in getting residents down stairs if needed. LPA tour of the facility did not reveal any obvious signs of disrepair or neglect to the physical plant. It is alleged that since the facility stopped providing water bottles that the facility is not able to meet operational costs for care of residents. LPA learned through interviews that the facility replaced water bottles with water stations. There are water stations in place in the memory care, at the front desk, in the dining area and in the second story activities room. In addition, the facility replaced cans of soda with a soda fountain and installed a vending machine for resident use. The facility has a bistro that is always accessible to residents with a refrigerator with prepared snacks, cookies, pastries, a coffee and tea station and bowls of fruit available. Eight (8) of eight (8) residents interviewed indicated that they have access to water and snacks and that the facility is meeting their needs. LPA did not observe any indications that the facility was not meeting the needs of the residents due to operational budget on this date. Based on the information available during this investigation we have found the complaint allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 201-3990
LICENSING EVALUATOR SIGNATURE:	DATE: 10/03/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023

LIC9099 (FAS) - (06/04)

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