336405886-10-1-2025-18-AS-RORN-DM9UN2-20251008154314

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336405886
Report Date: 10/01/2025
Date Signed: 10/01/2025 04:12:40 PM

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-20220511160759

FACILITY NAME:	INTEGRATED CARE COMMUNITIES - B2		FACILITY NUMBER:	336405886
ADMINISTRATOR:	EMELY C. RODRIGUEZ		FACILITY TYPE:	740
ADDRESS:	14315 NASON STREET		TELEPHONE:	(951) 601-9170
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92555
CAPACITY:	20	CENSUS: 15	DATE:	10/01/2025
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Emily Rodriguez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility failed to assist resident with administration of medications.

INVESTIGATION FINDINGS:

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On October 1, 2025, the Department of Social Services staff conducted an unannounced visit to this facility to continue investigation of the above allegation and to deliver findings. The Department was met by Administrator Emily 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 allegation 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 physcian's report (dated:11/19/21, 2/15/18), Needs and Services Plan (dated 2/27/18). 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 3 staff 1- (S1-S3 ) and Administrator (A1). The Department interviewed 3 residents (R2-R4).
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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

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-20220511160759

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: 10/01/2025

NARRATIVE

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The investigation revealed the following:

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

The detail of the complaint alleges that R1 wasn’t receiving medication at the facility during the time of March 2022-May 2022..

On October 1, 2025, the Department conducted a review of R1 Medication Administration Record (MAR) for March 2022, April 2022 and May 2022. Records revealed that all of R1's medication including PRNs were given and properly initialed by staff; no discrepancies found.

On October 1, 2025 at 1:17pm, 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 an 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 1:00pm and 2:00pm, The Department interviewed 3 staff regarding the allegation and of those interviewed, 3 out 3 stated that at no time has R1 missed any of her medication. Additionally, 3 out of 3 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: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220511160759

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: 10/01/2025

NARRATIVE

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On October 1, 2025 between 2:45pm and 3:40pm, the Department interviewed 3 Residents (R-2 -R4). The Department was unable to interview R1 as she reportedly passed away on August 2023. Of those interviewed, 3 out of 3 state they receive their medication as prescribed and on time and that they have never miss medication due to staff not giving it.

According to 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.

There were no deficiencies cited during today's visit.

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

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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