366426710-8-18-2023-56-AS-KCLS-CUXRB8-20230822125215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426710
Report Date: 08/18/2023
Date Signed: 08/18/2023 10:50:06 AM

Unsubstantiated

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
08/11/2023 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20230811153202

FACILITY NAME:	LINDA VALLEY ASSISTED LIVING		FACILITY NUMBER:	366426710
ADMINISTRATOR:	BROOKE ABREGO		FACILITY TYPE:	740
ADDRESS:	25393 COLE ST.		TELEPHONE:	(909) 799-3117
CITY:	LOMA LINDA	STATE: CA	ZIP CODE:	92354
CAPACITY:	64	CENSUS: 49	DATE:	08/18/2023
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Eileen Sanchez Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff failed to comply with infection control practices resulting in a H&S risk.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the mentioned allegation. LPA Allen met with Administrator Eileen Sanchez who was informed of the purpose of the visit.

LPA Allen conducted interviews with three (3) staff members, four (4) residents and records were reviewed. The interviews conducted with 3 staff members stated that the facility has followed the guidelines and regulations related to the infection control, prevention, and mitigation for communicable diseases in the facility.

LPA attempted to interviewed two (2) residents R1, R2, who were unable to confirm or deny that they were exposed to Covid-19. LPA interviewed Resident 3 and Resident 4 who stated that there was Covid-19 cases in their unit and guidance was followed by the staff.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

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-20230811153202

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: LINDA VALLEY ASSISTED LIVING	FACILITY NUMBER: 366426710
	VISIT DATE: 08/18/2023

NARRATIVE

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Records were reviewed which confirmed staff, residents and residents’ responsible parties were notified of the Covid-19 cases and that the facility has been following the guidelines and regulations related to the infection control, prevention, and mitigation for communicable diseases in the facility. They have also contacted the Department of Public Health and Department of Social Services.

Based on the interviews conducted with staff members, residents, and records reviewed the allegation is found to be Unsubstantiated. A finding of unsubstantiated means although the allegations 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 where the report was discussed with Eileen Sanchez and a copy of the report was provided at the conclusion of the visit with appeal rights.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2023

LIC9099 (FAS) - (06/04)

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