366423875-3-4-2024-56-AS-NBRN-D3CW2H-20240314165421

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423875
Report Date: 03/04/2024
Date Signed: 03/04/2024 02:25:58 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
02/28/2024 and conducted by Evaluator Bianca Wolcott

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240228135949

FACILITY NAME:	MISSION OF LOVE II		FACILITY NUMBER:	366423875
ADMINISTRATOR:	JESSICA V. VILLANUEVA		FACILITY TYPE:	740
ADDRESS:	11991 7TH AVENUE		TELEPHONE:	(760) 947-5211
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	14	CENSUS: 14	DATE:	03/04/2024
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Jessica Villanueva		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not ensure that the facility remains free of odors
Staff did not assist resident with incontinence needs
Staff did not prevent resident from developing a pressure injury while in care
Staff did not ensure an adequate quantity of food was served to resident in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott conducted an unannounced visit to the facility for the purpose of initiating the investigation and delivering findings of the above allegations. LPAs met with licensee Jessica Villanueva who was advised of the purpose of today's visit. The investigation consisted of observations of the physical plant, review of records, and interviews with relevant parties.

Allegation 1: Staff did not ensure that the facility remains free of odors LPAs and License toured the facility including all resident bedrooms and bathrooms and found the facility to be clean with absence of foul odors. LPAs observed facility staff bring soiled clothing and beddings to the laundry area thought the visit. Interviews with staff revealed that all residents are receiving laundry services as part of basic services. Additionally, there is no schedule for laundry services – it is done every day and as needed.

Allegation 2: Staff did not assist Resident with incontinence needs. Interviews with staff reveal that most residents are incontinent and wear briefs. LPAs observed Resident with a fresh diaper. Through interviews, it was discovered

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Bianca Wolcott	TELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

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-20240228135949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MISSION OF LOVE II	FACILITY NUMBER: 366423875
	VISIT DATE: 03/04/2024

NARRATIVE

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discovered that staff check on residents about every two hours and soiled briefs are changed during checks or as needed, per residents request. LPAs observed staff assist residents with toileting.

Allegation 3: Staff did not prevent Resident from developing a pressure injury while in care. Through interviews, LPAs were informed that resident was receiving hospice services when they sustained an injury. Witness interviewed revealed that Resident pressure injury was due to their combative behavior that has been addressed. LPAs observed Resident with pressure sore protection.

Allegation 4: Staff did not ensure an adequate quantity of food was served to resident in care. LPAs were present during lunch services and observed staff offer seconds. LPAs observed staff assist residents who require food intake assistance. LPAs inspected kitchen refrigerators and pantry and found the facility stores more than two days of perishable and seven days on nonperishable food items. Additionally, LPAS observed protein shakes for supplementary/meal alternate.

Based on the information revealed during the investigation, these allegations are therefore unsubstantiated. A finding of UNSUBSTANTIATED means, 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 with and a copy of this report was provided to Licensee.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Bianca Wolcott	TELEPHONE: (951) 248-0306
LICENSING EVALUATOR SIGNATURE:	DATE: 03/04/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/04/2024

LIC9099 (FAS) - (06/04)

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