366413246-10-13-2021-18-AS-NBRN-C88NHZ-20211028102934

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366413246
Report Date: 10/13/2021
Date Signed: 10/13/2021 12:57:11 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
10/06/2021 and conducted by Evaluator Amy Goldenberg

COMPLAINT CONTROL NUMBER: 18-AS-20211006131303

FACILITY NAME:	STERLING INN		FACILITY NUMBER:	366413246
ADMINISTRATOR:	BARBER, DONALD		FACILITY TYPE:	740
ADDRESS:	17738 FRANCESCA ROAD		TELEPHONE:	(760) 245-2999
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92392
CAPACITY:	185	CENSUS: 101	DATE:	10/13/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Don Barber, Executive Director		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility is not following COVID protocols.

INVESTIGATION FINDINGS:

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This unannounced visit conducted by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to initiate the 10 day visit to investigate the above mentioned complaint allegation.

During this visit LPA interviewed staff from maintenence, housekeeping, caregiving, nursing and Administration. LPA toured the facility and assessed facility personal protective equipment (PPE) supply, dining room practices, entrance screening practices and LPA took pertinent photographs. LPA observed the following: The facility has one central entry point. All visitors are screened upon entry using a digital system called Zoho Public Survey Screening. The automated device screens temperature and requires visitors to complete a survey to receive permission to enter the facility. The facility has two cups of pens at the entry point, one for sanitized pens and one for used pens to be sanitized. There are hand washing and sanitizer stations located at the entry point and at central points throughout the faciliy.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

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 18-AS-20211006131303

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
RIVERSIDE, CA 92507

FACILITY NAME: STERLING INN	FACILITY NUMBER: 366413246
	VISIT DATE: 10/13/2021

NARRATIVE

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The facility PPE supply is ample and isolation carts are readied awaiting use. The facility has posted in each restroom and hand washing station, hand washing and COVID-19 prevention guidelines. The dining room is restricted to residents only. The guidelines in place are for there to be only two residents at one table according the the Executive Director. LPA observed those tables are screened with a plexiglass divider between the residents. Each table has two chairs, one on either side of the plexiglass. The availability of hand sanitizer to the residents is visible. Social distance protocol is encouraged and community seating areas are marked with " Do not sit here " stickers. Coffee and water stations are equipt with wrapped individual use cups and stirrers. All employees and visitors are required to wear a mask while in the community and encouraged to be either vaccinated or with a negative COVID-19 test prior to entrance into the facility. LPA did not observe any resident or employee not wearing a mask. Five (5) out of five (5) employees interviewed revealed that staff have been provided with COVID-19 protocol training. The facility housekeeping reports that the practice is to hourly wipe down commonly touched surfaces and that when isolation ends they sanitize rooms with using a disinfecting spray noted as "Holt" as well as a hydrostatic sanitizing machine according to the Executive Director. Two (2) of Two (2) caregivers interviewed report that they have been trained on isolation procedures. Copies of training records have been reviewed and copies of training records have been obtained. Residents and staff are tested with a rapid test weekly on Tuesdays and Thrusdays and if a positive test is reported it is followed with additional testing to verify the positive. Three (3) of three (3) staff questioned on isolation practices noted that isolation is initiated with rapid testing positives. Based on the available information obtained during this investigation there is no discernable violation and this investigation is concluded.

We have found the complaint allegation is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. A copy of this report is being reviewed with, and furnished to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2021

LIC9099 (FAS) - (06/04)

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