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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530062
Report Date: 02/05/2025
Date Signed: 02/05/2025 02:41:40 PM

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
11/09/2023 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231109085136
FACILITY NAME:TWIN HEARTS SENIOR CARE IIFACILITY NUMBER:
335530062
ADMINISTRATOR:MANGENTE, KRISTINEFACILITY TYPE:
740
ADDRESS:342 E OLIVE STREETTELEPHONE:
(951) 373-9122
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:6CENSUS: 6DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:caregiver Juwita P. Elisabeth TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
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5
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9
Staff violated resident's personal rights by not allowing visitors.
Staff denied hospice services to resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to investigate and deliver findings on the allegations listed above. LPA met with caregiver Juwita P. Elisabeth explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews, and resident interviews.

For the allegation, Staff violated resident's personal rights by not allowing visitors.

During staff interviews, all staff stated residents’ visitors are allowed to visit during facility hours but will accommodate with resident preferences. During residents' interviews, 1 out of the 5 residents stated their visitors have not been deny access. In addition, 4 out of the 5 residents were unable to corroborate on the above allegation.

During record review, LPA Rico observed the facility has a designated visitor check-in.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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-20231109085136
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: TWIN HEARTS SENIOR CARE II
FACILITY NUMBER: 335530062
VISIT DATE: 02/05/2025
NARRATIVE
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For the allegation, Staff denied hospice services to resident.

During staff interviews, all staff stated they have not denied hospice services to resident. During resident interviews, 1 out of the 5 residents stated they do not require hospice services. In addition, 4 out of the 5 residents were unable to corroborate on the above allegation.

Based on the evidence found during the investigation, the two (2) 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 caregiver Juwita P. Elisabeth.

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

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2