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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881248
Report Date: 08/01/2024
Date Signed: 08/01/2024 01:37:30 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
05/31/2024 and conducted by Evaluator Magda Malcore
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240531155038
FACILITY NAME:WESTFIELD VILLA GARDENSFACILITY NUMBER:
331881248
ADMINISTRATOR:ALMA ESPINALFACILITY TYPE:
740
ADDRESS:3863 WEST RAMSEY STTELEPHONE:
(951) 849-7521
CITY:BANNINGSTATE: CAZIP CODE:
92220
CAPACITY:50CENSUS: 34DATE:
08/01/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Alma Espinal - AdministratorTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Facility staff are not assisting resident with hygiene needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Magda Malcore conducted an unannouced complaint visit to the facility. LPA met with Alma Espinal, Administrator, and was informed of the visit.

Regarding the allegation, facility staff are not assisting resident with hygiene needs, During today's visit, LPA observed ants on resident #1(R1's) mattress. R1 lifted their pillow and several ants were observed on the pillow. Two (2) staff immediately changed the linen and mopped the floors. Interviews with staff reveal that R1 often eats in his bed and could be attracting the ants. LPA record review reveals, on 6/29/24, R1 was seen by a medical professional who described R1 as having poor personal hygiene.

Based on LPA record review and observations, the allegation 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.

An exit interview was conducted where reports (LIC9099&LIC9099-D) were discussed and provided with appeal rights to the Administrator at the conclusion of the visit.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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-20240531155038
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: WESTFIELD VILLA GARDENS
FACILITY NUMBER: 331881248
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/02/2024
Section Cited
CCR
87307(a)(3)(C)
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87307 Personal Accommodations and Services.(a)Living accommodations...shall be related to the facility's function... Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available...(C)clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, ...shall be sufficient to permit changing at least once per week or more often...to ensure that clean linen is in use by residents at all times..This requirement is not met as evidenced by:
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Two staff immediately changed R1's bed linen and mopped the floors. The Licensee and/or Administrator shall submit to the Licensing Agency a written certification of understanding on the regulation cited by POC date.
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The Licensee did not comply with the section cited by R1 had several ants on bed and assessed with poor hygiene, which poses an immediate health, safety or personal rights risk to persons in care.
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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: Karen Clemons
LICENSING EVALUATOR NAME: Magda Malcore
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2