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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426055
Report Date: 10/12/2022
Date Signed: 10/12/2022 12:25:51 PM

Substantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20221006095346
FACILITY NAME:BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)FACILITY NUMBER:
366426055
ADMINISTRATOR:MARGUERITE CROCKEMFACILITY TYPE:
740
ADDRESS:28807 BASELINE STREETTELEPHONE:
(909) 742-7353
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:115CENSUS: 90DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Angela LaflerTIME COMPLETED:
12:29 PM
ALLEGATION(S):
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Facility mismanaged resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate the above mentioned complaint allegation and deliver findings. LPA identified herself to Health Services Coordinator Angie Lafler who was notified of the reason for today’s visit and the elements of the allegation. Executive director Marguerite Crockem arrived shortly and was informed of the purpose of today's visit. The investigation included staff interviews and records review.

It is alleged that the Facility mismanaged resident's medications. On 9/15/22, Resident 1 (R1) ran out of one (RX) of their two scheduled medication. Records reveiwed showed that the facility continued to update the medication record for RX as DNA-Drug not available on 9/16/22 and 9/17/22 and as HLD-Medication on Hold from 9/18/22 through the morning of 10/6/22. The RX was filled in the evening of 10/6/22 and R1 has been taking the RX consistently to date. Records reviewed and staff interviews revealed that the facility did not communicate with R1's responsible party between 9/15/22 through 10/4/22 that the RX has ran out and has not been filled. Based on the information, this complaint in substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
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 4
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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/06/2022 and conducted by Evaluator Anna Bueno
COMPLAINT CONTROL NUMBER: 56-AS-20221006095346

FACILITY NAME:BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)FACILITY NUMBER:
366426055
ADMINISTRATOR:MARGUERITE CROCKEMFACILITY TYPE:
740
ADDRESS:28807 BASELINE STREETTELEPHONE:
(909) 742-7353
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:115CENSUS: 90DATE:
10/12/2022
UNANNOUNCEDTIME BEGAN:
08:57 AM
MET WITH:Angie LaflerTIME COMPLETED:
12:29 PM
ALLEGATION(S):
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Facility did not administer medication to resident correctly according to doctor's orders.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate the above mentioned complaint allegation and deliver findings. LPA identified herself to Health Services Director Angie Lafler who was notified of the reason for today’s visit and the elements of the allegation. The investigation included records review.

The allegation is that the facility did not administer medication to resident correctly according to doctor's orders. LPA reviewed Resident 1 (R1) full medication records from 9/1/22 through today and found that medications were being administered as prescribed. Medication that ran out were marked accordingly as DNA-Drug not available and as HLD-Medication on Hold until it was filled.

A finding of UNSUBSTANTIATED means 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. An exit interview was conducted with Mrs. Lafler and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20221006095346
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
, CA 92507
FACILITY NAME: BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)
FACILITY NUMBER: 366426055
VISIT DATE: 10/12/2022
NARRATIVE
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A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. This poses and immediate health and safety risk to residents in care.

Refer to LIC809-D for deficiency cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Ms. Lalfler.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20221006095346
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
, CA 92507

FACILITY NAME: BRIGHTWATER SENIOR LIVING OF HIGHLAND (DBA)
FACILITY NUMBER: 366426055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/13/2022
Section Cited
CCR
874659(d)(1)
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If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms...Facility staff shall contact the resident's physician prior to each dose, describe the resident's symptoms, and receive direction to assist the resident in self-administration of that dose of medication
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Licensee shall submit proof of training that residents are not without medication and that responsible parties are notified accordingly. Proof of the correction will be submitted to the Department before the end of POC date 10/13/2022.
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This requirement was not met as evidenced by:
Records reviewed and staff interviews confirmed that Resident 1 (R1) scheduled medication ran out on 9/15/22 and the facility did not communicate with R1's family that the medication has not been filled until 10/5/22.
This poses and immediate health and safety risk to residents in care.
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Prior to today's visit, Health Services Director verfiied that a re-training has been scheduled for med tech staff and will be completed no later than 10/20/2022.
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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: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4