366425325-1-23-2024-56-AS-EMAN-D2VQFZ-20240228110842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425325
Report Date: 01/23/2024
Date Signed: 01/23/2024 12:29:45 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
01/17/2024 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240117142158

FACILITY NAME:	CHANTILLY LACE MANOR		FACILITY NUMBER:	366425325
ADMINISTRATOR:	TERESA BADDELEY		FACILITY TYPE:	740
ADDRESS:	7421 MINSTEAD AVE		TELEPHONE:	(760) 552-9980
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	6	CENSUS: 6	DATE:	01/23/2024
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Teresa Baddeley- Administrator		TIME COMPLETED:	12:38 PM

ALLEGATION(S):

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Facility staff did not dispense medications as prescribed.
Facility staff withheld food from resident.
Facility staff withheld water from resident.
Facility staff is giving the residents alcohol.
Facility staff is using a physical restraint on resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to investigate and deliver findings for the allegations listed above. LPA stated the purpose of the visit, was granted entry, and met with Administrator Teresa Baddeley. The investigation consisted of resident interviews, staff interviews, and document review.

For allegation, Facility staff did not dispense medications as prescribed:

Interviews with the staff revealed that the facility is dispensing the resident’s medication as prescribed. Prior to dispensing, the staff reads the resident’s prescription containers to ensure they are dispensing as ordered. The staff stated the process is to remove the medication out of the prescription containers, place the medications into a reusable cup container, and then immediately hand the cup container to the residents, and the staff verifies the resident took the medication. Once the resident takes the medication, the staff logs and initials the medication in the resident's MAR record.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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-20240117142158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CHANTILLY LACE MANOR	FACILITY NUMBER: 366425325
	VISIT DATE: 01/23/2024

NARRATIVE

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Interviews with the residents revealed that there were no known issues with medication not being dispensed as prescribed. Document review of the residents MARs records revealed that the resident’s medication is being documented appropriately.

For allegation, Facility staff withheld food from resident:

Interviews with the staff and the residents revealed that the residents are not being withheld food. The residents are served breakfast, lunch, dinner, and snacks throughout the day. The meals served include a mixture of fruits, vegetables, protein, and carbohydrates. If the residents are not full after a meal, additional food is available and offered until the resident is full. Document review of the facilities menu revealed that the facility offers a mixture of fruits, vegetables, protein, and carbohydrates three (3) times a day. The staff and the residents both denied that the residents are withheld food.

For allegation, Facility staff withheld water from resident:

Interviews with the staff and the residents revealed that the residents are not being withheld water. The residents are offered water throughout the day. The staff and the residents both denied that the residents are withheld water.

For allegation, Facility staff is giving the residents alcohol:

Interviews with the staff and the residents revealed that the residents on occasion are provided alcohol. The alcohol is only provided at resident’s request due to the resident having personal rights. During these occasions, it is usually during a holiday and or a celebration. The residents are only provided a small amount of alcohol. The staff only allows alcohol if the resident is not on a medication that will interact with the alcohol.

For allegation, Facility staff is using a physical restraint on resident:

Interviews with the staff and the residents revealed that the resident’s are not being physically restrained. The facility staff utilizes a gait belt to assist the residents with their transfers and mobility.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20240117142158

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CHANTILLY LACE MANOR	FACILITY NUMBER: 366425325
	VISIT DATE: 01/23/2024

NARRATIVE

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The staff and the residents both denied that the residents are being physically restrained.

Overall, there was not enough evidence to collaborate the allegations listed above.

Based on evidence obtained during the investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided Administrator Teresa Baddeley, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-8222
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 836-3180
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

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