366425610-3-7-2023-56-AS-KCLS-CS3UBY-20230522152705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:31:05 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
03/06/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230306161027

FACILITY NAME:	EXCELCARE		FACILITY NUMBER:	366425610
ADMINISTRATOR:	ANDERSON, DORRIS		FACILITY TYPE:	740
ADDRESS:	11400 POPLAR STREET		TELEPHONE:	(909) 796-4553
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	10	CENSUS: 8	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Dorris Anderson, Administrator		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Facility staff does not ensure that facility has adequate lighting
Facility staff does not keep facility at a comfortable temperature
Facility staff does not provide resident adequate bedding
Facility staff does not ensure that resident is adequately fed
Facility staff inappropriately handled resident
Facility staff yelled at resident
Facility staff did not assist resident during an incident
Facility staff made an inappropriate comment(s) in front of resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore and Licensing Program Manager (LPM) Karen Clemons made an unannounced visit to the facility to conduct a complaint investigation regarding the above allegations. LPA Malcore and LPM Clemons met with Licensee Dorris Anderson and discussed the purpose of the visit. The investigation consisted of direct observations and interviews with residents and staff.

LPM toured the entire facility including common areas, bedrooms, bathrooms, and kitchen. LPM observed sufficient lighting throughout the facility. LPM toured bedrooms #1, #2, #3, #4, #5, #6, and #7 and checked all beds. Each bed observed has all the required bedding and linens for resident use. The facility has two linen closets that are stocked with sufficient supply of extra linens including blankets, sheets, pillowcases, and towels. LPM toured the kitchen and verified the food supply. The facility is stocked with plenty of perishable and non-perishable food items. LPM verified facility menu being followed daily. LPA and LPM observed the facility to be at a comfortable temperature during today’s visit. The temperature in the facility measures 73 degrees.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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-20230306161027

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: EXCELCARE	FACILITY NUMBER: 366425610
	VISIT DATE: 03/07/2023

NARRATIVE

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Regarding staff does not ensure that residents are adequately fed, the licensee stated that all residents are served three full meals each day. Licensee stated that the residents usually say that it is too much food. If the residents want seconds, they can have it when requested. Three out of four residents interview said they are all adequately fed with plenty of food.

Regarding staff inappropriately handled resident, LPA and LPM interviewed four residents, the licensee and two staff. All residents interviewed deny being inappropriately handled in the facility. All staff interviewed deny inappropriately handling residents. There are no witnesses to corroborate the allegation.

Regarding staff yelled at resident, LPA and LPM interviewed four residents, two staff, and the licensee. All persons interviewed deny that staff yell at the residents. The residents say they like living here and they like the staff.

Regarding staff did not assist resident during an incident, interviews conducted with facility staff and residents did not corroborate that there was an incident that was not addressed by facility staff.

Regarding staff made an inappropriate comment in front of resident, four residents interviewed deny that staff made inappropriate comments to them. All staff deny being inappropriate towards residents. There are no witnesses to corroborate the allegation.

Based on evidence obtained during the investigation, the above allegations are Unsubstantiated; meaning that 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. No deficiencies cited during this visit.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Dorris Anderson at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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