366425610-3-10-2023-56-AS-KCLS-CT6RNU-20230626131052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425610
Report Date: 03/10/2023
Date Signed: 03/10/2023 12:14:50 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
02/21/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230221092922

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: 9	DATE:	03/10/2023
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Dorris Anderson, Licensee		TIME COMPLETED:	12:18 PM

ALLEGATION(S):

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Staff hit residents
Staff do not provide food of Quantity to meet the needs of residents
Meals do not consist of an appropriate variety of foods and are not planned with consideration for food habits of residents.
Staff do not treat residents with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to continue the complaint investigation and deliver findings on the above complaint allegations. LPA met with Licensee Dorris Anderson and discussed the purpose of the visit. The investigation consisted of interviews with residents, staff, and additional document review.

Regarding staff hit residents, all staff interviews deny hitting and/or witnessing staff hitting residents. Based on interviews with resident #1, #2, #3, #4, #5, #6, and #7; there are not enough witnesses to corroborate the allegation.

Regarding staff do not provide food of quantity to meet the needs of residents, all staff interviews deny not providing food of quantity to meet the needs of residents. All staff stated that residents are provided 3 meals a day, including snacks. Six out of seven residents said that they are provided plenty of food to meet their needs.

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: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

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-20230221092922

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: 03/10/2023

NARRATIVE

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Regarding meals do not consist of an appropriate variety of foods and are not planned with consideration for food habits of residents, LPA Malcore toured the kitchen and food supply. The facility is stocked with a variety of perishable and non-perishable food items. LPA viewed that menu which consisted of a variety of meals for breakfast, lunch, and dinner and verified that the menu is being followed. Six out of seven residents stated that meals consist of a variety of foods and that staff has made changes to the menu in consideration for food habits of residents.

Regarding staff do not treat residents with respect, all staff interviews deny not treating and/or witnessing other staff not treating residents with respect. Six out of seven residents interviewed stated that staff does treat them with respect.

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 Rose Viernes 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: 03/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023

LIC9099 (FAS) - (06/04)

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