374604325-8-26-2024-18-AS-TDAN-DB9QNC-20241122111855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604325
Report Date: 08/26/2024
Date Signed: 08/26/2024 10:35:00 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
04/08/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240408115511

FACILITY NAME:	MARAMA		FACILITY NUMBER:	374604325
ADMINISTRATOR:	SANDISON, HEATHER		FACILITY TYPE:	740
ADDRESS:	727 ASCOT DRIVE		TELEPHONE:	(760) 505-3019
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	12	CENSUS: 0	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Heahter Sandison - Administrator		TIME COMPLETED:	10:35 AM

ALLEGATION(S):

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Facility staff not assisting resident with mobility needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegation listed above. LPA met with Administrator Heather Sandison who was informed of the purpose for the visit. The investigation consisted a tour of the interior/exterior areas of the facility, interviews with staff, and records review of requested pertinent documents.

Regarding the allegation "Facility staff not assisting resident with mobility needs", it was reported Resident One (R1) is a two person transfer and staff are transferring R1 as a one person transfer due to not enough staff being available. Interview with Director Karrie Shots revealed staff have been instructed that R1 is a two person assistance with transferring. LPA conducted interviews with four (4) out of four (4) staff who reported R1 is a two person transfer and they use a gait belt to transfer R1 out of bed. Four (4) out of four (4) staff reported the facility has not experienced staff shortages that could effect the quality of care and supervision to residents in care. Three (3) out of four (4) staff reported they have never transferred R1 by themselves and they always have an additional staff present to perform the two person transfer for R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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 18-AS-20240408115511

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MARAMA	FACILITY NUMBER: 374604325
	VISIT DATE: 08/26/2024

NARRATIVE

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Records review of R1's care summary page indicates R1 is a "Two person assistance with transferring" and Physician’s Report LIC 602 corroborated R1 needed staff assistance with transferring. LPA attempted to interview R1 but due to R1 being non-verbal, additional information could not be obtained. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Administrator Sandison.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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