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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800490
Report Date: 10/27/2023
Date Signed: 10/27/2023 07:48:14 PM

Substantiated


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
02/07/2022 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220207165851
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:
10/27/2023
UNANNOUNCEDTIME BEGAN:
04:22 PM
MET WITH:Sharee GlissonTIME COMPLETED:
08:00 PM
ALLEGATION(S):
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Staff attempted to gain access to resident's financial account.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met Sharee Glisson and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record review.

For allegation, Staff attempted to gain access to resident's financial account.

During document review, LPA reviewed R5 bank statements from 2019,2020 and 2022.
During interview with R5, R5 informed LPA they have no access to their money or credit cards. R5 stated Administrator and S2 have access to their credit cards and money. In addition, regarding the transactions made in 2019, 2020, 2022 R5 stated they did not approve of any purchases that were made. R5 informed LPA they have not travel to the locations that were listed in the statements.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
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 3
Control Number 18-AS-20220207165851
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: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/28/2023
Section Cited
CCR
87217(a)
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87217(a) Safeguards for Resident Cash, Personal Property, and Valuables (a) A licensee shall not be required to handle residents' cash resources. handling his own cash resources, ..shall be safeguarded in accordance with the regulations in this section.
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Licensee will send proof they have read and understood the regulation. Licensee will have someone else take over R5 finances.
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 Based on record review, the licensee did not comply with the section cited above by having access to R5 credit cards which poses which poses an immediate health, safety, or personal rights risk to persons in care.
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POC due date by 10/28/2023
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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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20220207165851
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: VILLA DESCANSO SENIOR LIVING
FACILITY NUMBER: 331800490
VISIT DATE: 10/27/2023
NARRATIVE
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During interview with Administrator, Administrator stated R5 has no family. Administrator will assist R5 with their finances.

Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met.



During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed through the phone to Administrator Gabriela Thompson and provided to Sharee Glisson along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3