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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880730
Report Date: 02/14/2025
Date Signed: 02/14/2025 11:51:47 AM

Unsubstantiated


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
07/07/2022 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220707144410
FACILITY NAME:MORNING MIST HOMECAREFACILITY NUMBER:
331880730
ADMINISTRATOR:SANASINH, SIMMFACILITY TYPE:
740
ADDRESS:7902 NATOMA STTELEPHONE:
(949) 233-1643
CITY:EASTVALESTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 6DATE:
02/14/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Staff- Leticia MagnoTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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9
Resident developed multiple pressure injuries while in care.
Staff are not allowing a resident to leave his bed while in care.
Resident is not being fed while in care.
Staff are mishandling a resident's medications.
Resident is not attending medical appointments as required.
Staff are talking inappropriately towards a resident while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with staff Leticia Magno and explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and record review.

For the allegation, Resident developed multiple pressure injuries while in care.

During staff interviews, 5 out of the 5 staff stated that R1 did not developed pressure injuries while in care. During resident interviews R1 admitted they did not develop pressure injuries while in care.

For the allegation, Staff are not allowing a resident to leave his bed while in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
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 56-AS-20220707144410
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: MORNING MIST HOMECARE
FACILITY NUMBER: 331880730
VISIT DATE: 02/14/2025
NARRATIVE
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During staff interviews, 5 out of the 5 staff stated residents are allowed leave their bed. 5 out of the 5 staff also stated resident will have their meals in the dining room and will participate in facility activities. During resident interviews, 3 out of the 3 residents stated they are allowed to leave their bedroom and receive assistance to leave their bedroom.

For the allegation, Resident is not being fed while in care.

During staff interviews, 5 out of the 5 staff stated residents are receiving their meals. During resident interviews, 3 out of the 3 residents stated staff will serve breakfast, lunch, dinner, and snacks in between. During facility tour, LPA observed the facility has sufficient non-perishable and perishable food supply for the number of residents in care.

For the allegation, Staff are mishandling a resident's medications.

During staff interviews 5 out of the 5 staff stated they are not mishandling resident medications. During residents’ interviews, 3 out of the 3 residents stated they receive their medications. During medication audit, LPA observed resident’s medications dispense properly and documented accordingly.

For the allegation, Resident is not attending medical appointments as required.

During staff interviews 5 out of the 5 staff stated the Administrator will take the residents to their medical appointments if the resident’s responsible party is unable to. During resident interviews, 3 out of the 3 residents stated staff and their family members will assist with their medical appointments.

For the allegation, Staff are talking inappropriately towards a resident while in care.

During staff interviews 5 out of the 5 staff stated they do not speak inappropriately to their residents. During resident interviews, 3 out of the 3 residents stated staff do not speak inappropriately to them. In addition, R1 admitted to being intoxicated and yelling at staff.

Based on the evidence found during the investigation, the six (6) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.An exit interview was conducted, and this report (LIC9099) was discussed and provided to staff Leticia Magno.


SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2