366425834-4-29-2021-18-AS-EMAN-C5QSKS-20210809135713

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425834
Report Date: 04/23/2021
Date Signed: 04/29/2021 11:08:38 AM

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
08/28/2019 and conducted by Evaluator Elecia Weathersby

COMPLAINT CONTROL NUMBER: 18-AS-20190828120107

FACILITY NAME:	FOREMOST SENIOR CAMPUS		FACILITY NUMBER:	366425834
ADMINISTRATOR:	NIRUPAMA VANGALA		FACILITY TYPE:	740
ADDRESS:	17581 SULTANA STREET		TELEPHONE:	(760) 244-5579
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	96	CENSUS: 18	DATE:	04/23/2021
		UNANNOUNCED	TIME BEGAN:	01:19 PM
MET WITH:	Administrator - Pam Duro		TIME COMPLETED:	01:28 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elecia Weathersby made an unannounced telephonic-visit (Due to COVID-19) to the facility to deliver findings regarding the above allegations. The following is a summary of the meeting.

Based on investigating LPA (R. Zeron) observations and interviews, which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is SUBSTANTIATED. California Code of Regulations (Title 22, Division 6 and Chapter 8) is being cited on the attached LIC9099D.

LPA interviewed pertinent sources and information revealed that the air conditioning unit was out of service for an extended period of time of at least two weeks, based on 11 interviews conducted. According to interviews, staff indicated the facility did provide a swamp cooler but the residents and staff still complained the heat exceeded 100 degrees. Interviews revealed the swamp cooler was not sufficient due to the humidity in the afternoon. LPA verified that there were comfortable accommodations available. This facility had another wing that was not in use. The residents could have been moved. Interviews revealed the residents were not moved to this wing because it was felt that the swamp coolers and fans provided was sufficient. Based on the facility’s lack of providing comfortable accommodations in extreme heat, this was an immediate health and safety risk for residents in care. The allegation, the facility is in disrepair, is Substantiated.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

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-20190828120107

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: FOREMOST SENIOR CAMPUS	FACILITY NUMBER: 366425834
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/23/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type A 04/23/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Plan of Correction: Administrator repaired the facility air conditioner on 9/5/19. Evidence of the repair to be submitted to CCLD by email on 4/27/2021.
	8 9 10 11 12 13 14	Based on witness statements and interviews, the licensee did not ensure that the air conditioner was in proper working service for a period of at least two weeks. During this time, the temperature exceeded 100 degrees F. Licensee did not provide residents with comfortable accommodations, which poses an immediate health and safety risks to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Elecia Weathersby	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 04/23/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/23/2021

LIC9099 (FAS) - (06/04)

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