<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800490
Report Date: 10/17/2023
Date Signed: 10/17/2023 02:06:23 PM

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
03/23/2021 and conducted by Evaluator Amy Goldenberg
COMPLAINT CONTROL NUMBER: 18-AS-20210323113855
FACILITY NAME:VILLA DESCANSO SENIOR LIVINGFACILITY NUMBER:
331800490
ADMINISTRATOR:TORRES, GABRIELAFACILITY TYPE:
740
ADDRESS:6683 LEANNE STREETTELEPHONE:
(909) 332-0311
CITY:EASTVALESTATE: CAZIP CODE:
91752
CAPACITY:6CENSUS: 6DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sandra Hernandez, House ManagerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not pick up a resident timely after scheduled appointments
Staff does not properly feed a resident while in care
Staff misused a resident's personal funds
Staff mishandles a resident's medication
Staff forces a resident to sleep
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced visit by Amy Goldenberg, Licensing Program Analyst (LPA), is being conducted to conclude this agency’s investigation into the complaint allegations mentioned above.

During the course of the investigation, interviews were conducted with staff and residents, a review of resident records was completed and copy of pertinent documents obtained, menus and food supply were reviewed as well as medication records and storage. Investigation revealed the following : R1 no longer resides at the facility. It is alleged that facility staff do not arrive to pick up R1 until maybe 2-3 hours later and the client has to wait outside in the cold. LPA learned that the facility staff were not providing transportation for R1. R1's transportation was scheduled by their insurance through an outside vendor.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
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 18-AS-20210323113855
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: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
VISIT DATE: 10/17/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
It is alleged that R1 has a special diet and the staff do not feed them the proper diet. LPA interview with staff indicated that the residents are provided with their physician ordered diets. LPA review of the food supply indicated that the facility has nutritious foods available to feed the residents. Six (6) residents interviewed report that they receive the meals they require. It is alleged that the facility used R1's food stamp card and used approximately $230.00 from their card to purchase food for the whole house and the client was not reimbursed. There is no available evidence through review of records and interviews to support the allegation. LPA learned that the facility uses a digital medication treatment record called Adivantus. LPA review of medications and medication records do not reveal that the facility is mismanaging the residents medications. It is alleged that residents are forced to sleep. Five (5) of six (6) residents interviewed responded to questions regarding sleep times and five (5) of five (5) responded that they are not forced to go to bed at a specific time. Staff report that bedtimes are not enforced.

Based on the available information we have found the complaint allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and furnished to the facility representative
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Amy Goldenberg
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2