336405885-10-2-2025-18-AS-RORN-DMAMSH-20251009095158

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336405885
Report Date: 10/02/2025
Date Signed: 10/02/2025 09:22:59 AM

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
05/11/2022 and conducted by Evaluator Deborah Lee

COMPLAINT CONTROL NUMBER: 18-AS-20220511152553

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - B1		FACILITY NUMBER:	336405885
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14295 NASON STREET		TELEPHONE:	(951) 601-9150
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	20	CENSUS: 5	DATE:	10/02/2025
		UNANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Emely Rodriguez		TIME COMPLETED:	09:30 AM

ALLEGATION(S):

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Facility failed to ensure a supply of resident's medication
Facility failed to assist resident with administration of medications.
Facility failed to inform responsible party that medication was not being administered.

INVESTIGATION FINDINGS:

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On October 2, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegations and to deliver findings. The Department was met by Administrator Emely Rodriquez and the purpose of the visit was explained.

Investigation consisted of the following:
On 5/17/22, the Department conducted an unannounced initial visit to the facility to investigate the complaint allegations mentioned above. During the visit, it was determined that the complaint required further investigation.
On October 1, 2025, the Department toured facility’s med room, requested and received copies of the following: Staff roster (dated 9/3/25) Resident Roster (dated 10/1/25), R1’s Medication Administration Record (MAR)-dated March 2022, April 2022, May 2022, R1 physician’s report (dated 2/17/22), Needs and Services Plan (dated 10/10/23), Medication audit sheet (dated 5/25/22), staff medication training (dated: 7/3/25, 6/25/25, 6/15/25, 5/30/25, 4/25/25, 4/9/25). The Department conducted interviews with 4 staff (S1-S4 ) and Administrator (A1). The Department interviewed 4 residents (R2-R5).

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220511152553

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: INTEGRATED CARE COMMUNITIES - B1	FACILITY NUMBER: 336405885
	VISIT DATE: 10/02/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Facility failed to ensure a supply of resident's medication.

The detail of complaint alleges that there was a pharmacy change at the facility, and the pharmacy had trouble filling R1’s medication resulting in R1 only receiving 2 out of 9 of R1’ medications.

On October 1, 2025, the Department obtained, reviewed and evaluated R1 Medication Administration Record (MAR) for March 2022, April 2022 and May 2022. Records revealed that all R1's medications, including PRNs were given and properly initialed by staff; no discrepancies found. Additionally, the records reveal there weren’t any lapses in medication administration during the specified time frame as indicated in the complaint.

On October 1, 2025 at 9:35am, The Department interviewed Administrator (A1), who denied the allegation stating there were no reports of R1 missing medication as mentioned in the complaint. A1 went on to state that in the event a resident medication has not arrived due to any issue, the facility's pharmacy will provide them an emergency supply of medication until issue is resolved so that resident is not missing the medication.

On October 1, 2025, between 10:00am and 11:00am, The Department interviewed 4 staff regarding the allegation and of those interviewed, 4 out 4 stated that at no time has R1 missed any of her medication. Additionally, 4 out of 4 stated that medications for all residents are dispensed as prescribed and are on time.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220511152553

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: INTEGRATED CARE COMMUNITIES - B1	FACILITY NUMBER: 336405885
	VISIT DATE: 10/02/2025

NARRATIVE

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On October 1, 2025 between 11:00am and 12:00pm, the Department interviewed 4 Residents (R-2 -R5). The Department was unable to interview R1 as she reportedly moved out of facility on 12/31/24. No contact information provided. Of those interviewed, 4 out of 4 state they receive their medication as prescribed and on time and they have never missed medication due to staff not giving it.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

Allegation: Facility failed to assist resident with administration of medications.

The detail of the complaint alleges that R1 had not received the medication for her depression and pain.

On October 1, 2025, the Department obtained, reviewed and evaluated R1 Medication Administration Record (MAR) for March 2022, April 2022 and May 2022 in addition to the facility medication audit sheet (dated 5/25/22) which showed medication given and accounted for. Lastly, the Department also observed that any discontinued medication was properly noted on the MAR.

On October 1, 2025, at 9:35am, The Department interviewed Administrator (A1), who denied the allegation stating medications are always given and there have been no reports of missed medication. Additionally, A1 expressed that if a resident’s medication runs out, “our pharmacy would give an emergency supply of medication so that Residents won’t miss their medication.”

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220511152553

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: INTEGRATED CARE COMMUNITIES - B1	FACILITY NUMBER: 336405885
	VISIT DATE: 10/02/2025

NARRATIVE

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On October 1, 2025 between 11:00am and 12:00pm, the Department interviewed 4 Residents (R-2 -R5). Of those interviewed, 4 out of 4 residents state that they receive their medication as prescribed and on time and they have never missed medication due to staff not giving it.

Based on the information gathered there is insufficient evidence to support the allegation mentioned above; 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, therefore the allegation is UNSUBSTANTIATED.

Allegation: Facility failed to inform responsible party that medication was not being administered.

The detail of complaint alleges that R1’s Responsible Party received an invoice from the pharmacy which showed that most of R1’s medications ran out March 19, 2022, and 1 other medication ran out April 4, 2022.

On October 1, 2025, the Department conducted interview with A1 who denied the allegation stating that there was no missed medication, so there wasn’t a need to contact responsible party. A1 further explained that it is their practice to notify the responsible party if there are changes or if medications are “running low.” Lastly, A1 stated that not only do they inform the responsible party, but they also contact the resident’s Primary Care Physician.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220511152553

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: INTEGRATED CARE COMMUNITIES - B1	FACILITY NUMBER: 336405885
	VISIT DATE: 10/02/2025

NARRATIVE

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The review of R1’s MARs was consistent with A1’s assertion of no missed medication during that time frame.

There were no deficiencies cited during today's visit.

Exit interview conducted with Administrator Emely Rodriguez and copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2025

LIC9099 (FAS) - (06/04)

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