366425834-8-21-2024-56-AS-EMAN-D8KU3Z-20240828151418

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366425834
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:27:30 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
03/22/2024 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240322160955

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: 79	DATE:	08/21/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Dancia Turner		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff left resident in bed for extended period of time.
Staff isolated resident.
Staff did not ensure residents had call assistance buttons or pendants.
Staff did not ensure resident's physical therapy needs were met.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Danica Turner and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and record review.

For the allegation, Staff left resident in bed for extended period of time.

During staff interviews, 5 out of the 5 staff stated that have not left a resident in bed for extended period of time. 5 out of the 5 staff R1 does not like being in the wheelchair, R1 prefers to stay in bed. During resident interviews, R1 informed LPA they prefer to stay in bed.

During record review, R1 Physician Report from 2024 indicated R1 is bedridden.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

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-20240322160955

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: FOREMOST SENIOR CAMPUS	FACILITY NUMBER: 366425834
	VISIT DATE: 08/21/2024

NARRATIVE

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For the allegation, Staff isolated resident.

During staff interviews 5 out of the 5 staff informed LPA that in the daytime resident’s hangout in the common areas and go outside. 5 out of the 5 staff they check on R1 during their rounds or every two hours. During resident interviews. 5 out of the 5 resident stated they have not been isolated. R1 stated staff will come to their room when they call for assistance.

For the allegation, Staff did not ensure residents had call assistance buttons or pendants.

During staff interviews 5 out of the 5 staff stated R1 that has a call button but due to their arm condition they’re unable to press their button. 5 out of the 5 staff stated they check on R1 every hour. During resident interviews R1 stated that they are unable to use their call button due to their arms condition. During facility tour LPA observed residents call buttons to be working.

For the allegation, Staff did not ensure resident's physical therapy needs were met.

During staff interviews, 5 out of the 5 staff stated they are not licensed to provide physical therapy. 5 out of the 5 stated they encourage their residents to exercise their body. In addition, 1 out of the 5 staff stated R1 is waiting for their insurance to approve physical therapy 4 out of the 5-resident stated they do not require physical therapy.

Based on the evidence found during the investigation, the (4) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance to 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 Danica Turner.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary Rico	TELEPHONE: (951) 248-0293
LICENSING EVALUATOR SIGNATURE:	DATE: 08/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024

LIC9099 (FAS) - (06/04)

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