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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366425834
Report Date: 08/21/2024
Date Signed: 08/21/2024 01:31:42 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 CAMPUSFACILITY NUMBER:
366425834
ADMINISTRATOR:NIRUPAMA VANGALAFACILITY TYPE:
740
ADDRESS:17581 SULTANA STREETTELEPHONE:
(760) 244-5579
CITY:HESPERIASTATE: CAZIP CODE:
92345
CAPACITY:96CENSUS: 79DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Danica Turner TIME COMPLETED:
01:50 PM
ALLEGATION(S):
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Facility staff did not keep resident's room clean.
Facility staff is not providing adequate laundry service.
Facility is malodorous.
Facility staff did not safeguard residents’ personal belongings.
Staff did not ensure that resident’s dental needs were met.
Staff did not ensure that resident’s hygiene 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, resident interviews and record review.

For the allegation, Facility staff did not keep resident's room clean.

During staff interviews, 5 out of the 5 stated that they will clean residents rooms when needed, and house keepers will have designated rooms they must clean for the day. In addition, 5 out of the 5 staff stated that some resident will refuse for their room to be clean. During resident interviews 5 out of the 5 residents stated staff will clean their room once a week. During record review, LPA received a copy of housekeeping room assessment.

For the allegation, Facility staff is not providing adequate laundry service.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (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)
Page: 1 of 2
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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During staff interview 5 out of the 5 staff stated that each resident has a designated laundry day. During resident interviews 5 out of the 5 staff stated their clothes are washed by staff members. During facility tour, LPA observed resident’s laundry day posted in their bedroom. In addition, LPA received a copy of all resident’s laundry schedule.

For the allegation, Facility is malodorous.

During staff interviews, 5 out of the 5 staff informed LPA the facility is not malodorous. During resident interviews 5 out of the 5 residents stated the facility will smell bad when someone has an accident. 4 out of the 5 resident staff will clean their accident to avoid a strong odor.

For the allegation, Facility staff did not safeguard residents’ personal belongings.

During staff interviews, 5 out of the 5 staff stated they are not responsible for resident finances. 4 out of the 5 staff stated that each resident has their own dresser for their own clothes. During resident interviews 5 out of the 5 residents stated they personal belongings are not missing.

For the allegation, Staff did not ensure that resident’s dental needs were met.

During staff interviews, 5 out of the 5 staff stated that some residents are independent for their own dental needs. 5 out of the 5 staff stated that they will provide dental care needs for R1. During resident interviews 4 out of the 5 residents stated they they do not need assistance with their dental needs. 1 out of the 5 residents stated they receive assistance with their dental needs.

For the allegation, Staff did not ensure that resident’s hygiene needs were met.

During staff interviews 5 out of the 5 staff stated that residents who are independent staff will provide reminders to shower, change their clothes, and brush their teeth. During residents’ interviews, 4 out of the 5 residents stated they are independent for their own hygiene. 1 out of the 5 resident stated that they received assistance with their hygiene.

Based on the evidence found during the investigation, the (6) 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 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 Danica Turner.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Mary RicoTELEPHONE: (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)
Page: 2 of 2