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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336405886
Report Date: 08/06/2024
Date Signed: 08/06/2024 02:11:49 PM

Unfounded


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
08/05/2024 and conducted by Evaluator Stephanie Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240805130411
FACILITY NAME:INTEGRATED CARE COMMUNITIES - B2FACILITY NUMBER:
336405886
ADMINISTRATOR:EMELY C. RODRIGUEZFACILITY TYPE:
740
ADDRESS:14315 NASON STREETTELEPHONE:
(951) 601-9170
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:20CENSUS: 17DATE:
08/06/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Emely Rodriguez, AdministratorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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9
Staff did not refill resident’s medication prescription in timely manner.
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit.

A report was received by the Department alleging one medication was not refilled in time to administer to Resident One (R1) by the resident's medical provider on 08/02/2024 or 08/03/2024. The LPA's investigation included interviews with relevant parties; a review of records; and collection of relevant documentation. The LPA conducted a medication audit of R1's medications. Two medication containers were observed to be available at the facility for the medication in question. Both medication bottles had contents available for the administration of the medication. The LPA reviewed the Medication Administration Record (MAR) for August 2024 and observed staff initials to suggest the medication was administered on 08/01/2024 and on 08/03/2024. No staff initials were present for 08/02/2024. A representative of the resident's medical provider was
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
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 4
Control Number 18-AS-20240805130411
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 - B2
FACILITY NUMBER: 336405886
VISIT DATE: 08/06/2024
NARRATIVE
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interviewed and reported a visit to the facility was made by the representative during the first week of August 2024 there was no need to administer the medication at that time. Therefore, based on interview and observation, this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis.

This report was reviewed with Administrator Rodriguez and a copy of the report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
08/05/2024 and conducted by Evaluator Stephanie Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20240805130411

FACILITY NAME:INTEGRATED CARE COMMUNITIES - B2FACILITY NUMBER:
336405886
ADMINISTRATOR:EMELY C. RODRIGUEZFACILITY TYPE:
740
ADDRESS:14315 NASON STREETTELEPHONE:
(951) 601-9170
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92555
CAPACITY:20CENSUS: DATE:
08/06/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Emely Rodriguez, AdministratorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not keep an accurate medical log for residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Administrator, Emely Rodriguez, and informed her of the purpose for the visit.

A report was received by the Department alleging the facility was not keeping an accurate medical log relating to alleged discrepancies for Resident One's (R1's) medications. The LPA's investigation included interviews with relevant parties; a review of records; and collection of relevant documentation. The LPA conducted a medication audit of R1's medications in question. No discrepancies were observable to the LPA as both medications are prescribed as PRNs (Pro Re Nata) and to be given as needed. Staff interviews reported both staff and personnel responsible for R1's medical care have administered both medications; though only facility personnel document the times they administer the medication. The LPA reviewed the Medication Administration Record (MAR) for June, July and August 2024. No observable discrepancies were found. A representative of the company that provides medical care to R1 was interviewed and reported no concerns
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240805130411
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 - B2
FACILITY NUMBER: 336405886
VISIT DATE: 08/06/2024
NARRATIVE
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5
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have been observed when they have reviewed the resident's medications and medication records. Therefore, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

This report was reviewed with Administrator Rodriguez and a copy of the report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4