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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880541
Report Date: 06/06/2023
Date Signed: 06/06/2023 04:11:36 PM

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
06/02/2023 and conducted by Evaluator Stephanie Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230602124116
FACILITY NAME:ROLLING GREEN SENIOR CAREFACILITY NUMBER:
331880541
ADMINISTRATOR:OKORO, GERTRUDEFACILITY TYPE:
740
ADDRESS:42007 THOROUGHBRED LNTELEPHONE:
(951) 397-3369
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 4DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Gertrude Okoro, AdministratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff member is under the influence of a substance while providing care to residents.
Staff do not provide adequate care to resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Administrator, Gertrude Okoro, and informed her of the purpose for her visit.

The investigation included staff/resident interviews, records review, and records collection.

The Department received a report alleging Staff One (S1) has consumed a narcotic in the presence of a resident in care. Staff and resident interviews reported having no knowledge of who S1 is. According to Administrator Okoro, no one by S1's name, has worked or resided in the facility. She reported no one by S1's name has visited the facility recently. Staff and resident interviews reported having no knowledge of any person being under the influence of any substance while in the facility. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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 5
Control Number 18-AS-20230602124116
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: ROLLING GREEN SENIOR CARE
FACILITY NUMBER: 331880541
VISIT DATE: 06/06/2023
NARRATIVE
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It was also alleged facility staff were not providing care to Resident One (R1). R1 was interviewed; however, refused to provide information regarding the matter. Staff interviews revealed R1 was provided assistance with Activities of Daily Living (ADLs) and staff notes revealed R1 would occasionally refuse some services. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was reviewed with Administrator Okoro and a copy was provided.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
06/02/2023 and conducted by Evaluator Stephanie Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230602124116

FACILITY NAME:ROLLING GREEN SENIOR CAREFACILITY NUMBER:
331880541
ADMINISTRATOR:OKORO, GERTRUDEFACILITY TYPE:
740
ADDRESS:42007 THOROUGHBRED LNTELEPHONE:
(951) 397-3369
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:6CENSUS: 4DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Gertrude Okoro, AdministratorTIME COMPLETED:
04:20 PM
ALLEGATION(S):
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Staff is refusing to accept resident back into care.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegation. The LPA met with Administrator, Gertrude Okoro, and informed her of the purpose for her visit.

The investigation included staff/resident interviews, records review, and records collection. The Department received a report alleging Administrator, Gertrude Okoro, refused to accept back Resident One (R1) back into the facility following a hospital admission on June 05, 2023. Okoro was interviewed and admitted to refusing to allow R1 to return to the facility when it was reported R1 was ready for discharge following their hospital admission. Okoro reported R1 has been abusive toward staff and is not appropriate for the facility. She reported R1 was previously issued a Thirty-Day Notice of Termination of Tenancy, which would have been effective June 22, 2023. Therefore, based on the interview with the Administrator, this allegation is deemed SUBSTANTIATED at this time. A finding that the complaint is substantiated means the allegation is valid because the preponderance of the evidence standard has been met.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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 5
Control Number 18-AS-20230602124116
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: ROLLING GREEN SENIOR CARE
FACILITY NUMBER: 331880541
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
06/07/2023
Section Cited
CCR
87468.2(a)(20)
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Additional Personal Rights of Residents in Privately Operated Facilities: (a)..residents in privately operated RCFEs shall have all of the following... rights: (20) To be protected from involuntary transfers, discharges, & evictions. A licensee shall not involuntarily transfer or evict residents for reasons other than those
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The Administrator stated she is refusing to accept R1 back into the facility. When asked for a plan of correction she requested the LPA adise on how to correct. The LPA informed the Administrator the facility has to accept R1 back and follow eviction procedures and properly transfer R1.
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permitted... & shall comply w/ all eviction & relocation protections...This requirement wasn't met as evidenced by: Based on interview the Licensee didn't ensure R1 was free from an involuntary transfer. Okoro admitted to refusing to allow R1 to return to the facility. This posed a threat to the H&S of R1.
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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: Jazmond D Harris
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20230602124116
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: ROLLING GREEN SENIOR CARE
FACILITY NUMBER: 331880541
VISIT DATE: 06/06/2023
NARRATIVE
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An exit interview was conducted; the Administrator reported she is unwilling to accept back R1 into the facility because the resident is a danger to staff and other residents in care. The LPA notified the Administrator a three-day eviction can be issued to R1, though approval would be required from the Department. This report was reviewed with Administrator Okoro and a copy, along with instructions on Appeal Rights, was provided.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5