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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881016
Report Date: 03/30/2022
Date Signed: 03/30/2022 11:46:43 AM

Substantiated


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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220324152458
FACILITY NAME:INFINITE LOVE & CARE HOMESFACILITY NUMBER:
331881016
ADMINISTRATOR:RAMOS, ERIKAFACILITY TYPE:
740
ADDRESS:37-859 KENNET ST.TELEPHONE:
(760) 625-9936
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 5DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Erika Ramos - Administrator/LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Facility staff failed to provide requested resident's documents to Responsible Party

Facility staff discontinued administration of resident's medication without permission/order
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator/Licensee Erika Ramos. Below is a summary of the complaint investigation findings:

Regarding allegation "Facility staff failed to provide requested resident's documents to Responsible Party": LPA Colvin interviewed relevant parties, reviewed resident's (R1) file, and text messages and emails between relevant parties. LPA Colvin confirmed that R1's Power of Attorney (POA) requested multiple documents from R1's file from Administrator/Licensee Erika on 3/8/22, and while some doucments (such as oldest Physician's Report) was provided propmptly, the other records were not provided until yesterday, 3/29/22. Therefore, based on interviews and record review, the allegation "Facility staff failed to provide requested resident's documents to Responsible Party" is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
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-20220324152458
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
RIVERSIDE, CA 92507
FACILITY NAME: INFINITE LOVE & CARE HOMES
FACILITY NUMBER: 331881016
VISIT DATE: 03/30/2022
NARRATIVE
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Regarding allegation "Facility staff discontinued administration of resident's medication without permission/order": LPA Colvin reviewed R1's file at the facility, including the history of administration of R1's prescribed PRN ("as needed") medications. LPA Colvin observed that R1 is prescribed two PRN medications, and that the facility staff were administering these medications daily to R1 for a period of months in 2021. LPA Colvin inquired as to why the PRN medication for sleep was no longer being administered to R1, and LPA Colvin was informed that it is because R1 had been sleeping better. LPA Colvin reviewed R1's Physician's Report which indicates that R1 is unable to make their needs known. LPA Colvin interviewed Administrator/Licensee Erika about how these medications are administered and if there is a statement on file from the doctor regarding whether or not R1 can state their symptoms and need for the PRN medication. Erika stated that there is not a statement or form on file due to having submitted it to R1's doctor and not having gotten a response. LPA Colvin concluded that the facility staff are making the determination on when to administer the PRN medications to R1 without communicating with the prescribing doctor. Therefore, based on record review and interviews, the allegation "Facility staff discontinued administration of resident's medication without permission/order" is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Licensee/Administrator Erika Ramos during the exit interview.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20220324152458
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
RIVERSIDE, CA 92507

FACILITY NAME: INFINITE LOVE & CARE HOMES
FACILITY NUMBER: 331881016
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
04/13/2022
Section Cited
CCR
87468.2(a)(19)
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Additional Personal Rights..in Privately Operated Facilities: (a) In addition to the rights listed...residents...shall have all of the following personal rights: (19) To have prompt access to review all of their records...Photocopied records shall be provided within two (2) business... This requirement was not met by:
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Licensee agrees to review Title 22 Regulations section 87468,2 regarding personal rights of residents, and write a statement confirming review of the regulation section and understnading of the expectation of records being provided within 2 business days. Plan of Correction date is 4/13/22.
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Based on interviews and record review, the Licensee did not comply with the above regulation with one resident (R1). LPA Colvin confirmed that R1's POA requested all records for R1 on 3/8/22, but was not provided with all documents until 3/30/22. This is a potential personal rights violation of R1.
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Request Denied
Type B
04/13/2022
Section Cited
CCR
87465(d)(1)
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Incidental Medical and Dental Care: (d) If the resident is unable...to communicate his/her symptoms clearly, facility staff...shall be permitted to assist the resident...provided all of the following requirements are met: (1) Facility staff shall contact the resident's physician prior to each dose...This requirement was not met by:
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Licensee agrees to ensure a written statement is provided from each resident's doctor regarding their ability to communicate need or symptoms, prior to administering any PRN medications. Licensee to provide LPA Colvin with statement of understanding regarding this requirement. Plan of Correction Date is 4/13/22.
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Based on record review and interviews, the Licensee did not comply with the above regulation with at least one resident (R1). Facility staff have been deciding when to administer PRN medication to R1 without consulting with R1's doctor before each dose. R1 is unable to communicate needs. This is a health risk to 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: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/24/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220324152458

FACILITY NAME:INFINITE LOVE & CARE HOMESFACILITY NUMBER:
331881016
ADMINISTRATOR:RAMOS, ERIKAFACILITY TYPE:
740
ADDRESS:37-859 KENNET ST.TELEPHONE:
(760) 625-9936
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 5DATE:
03/30/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Erika Ramos - Administrator/LicenseeTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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2
3
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9
Facility Administrator not communicating updates on resident's care with Responsible Party
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Administrator/Licensee Erika Ramos. Below is a summary of the complaint investigation findings:

Regarding allegation "Facility Administrator not communicating updates on resident's care with Responsible Party": LPA Colvin interviewed Administrtor/Licensee Erika Ramos regarding the allegation, as well as reviewed R1's file and text messages between the Licensee and R1's Power of Attorney (POA). LPA Colvin was unable to obtain enough evidence to prove that the facility staff did not communicate updates with R1's care, as there were staff notes in R1's file regarding contacting POA when there was an emergeny with R1, and Licensee reports no other concerns with R1 during their care. Licensee additionally notes that POA visits the facility nearly every day, and if is not present, contacts the facility via telephone at least three times a day.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20220324152458
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
RIVERSIDE, CA 92507
FACILITY NAME: INFINITE LOVE & CARE HOMES
FACILITY NUMBER: 331881016
VISIT DATE: 03/30/2022
NARRATIVE
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Due to lack of evidence, the allegation "Facility Administrator not communicating updates on resident's care with Responsible Party" is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator/Licensee Erika Ramos and a copy of this report was provided
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5