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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409060
Report Date: 02/14/2023
Date Signed: 02/14/2023 12:28:01 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
02/01/2021 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210201151712
FACILITY NAME:INSPIRATIONS HOME CARE IIIFACILITY NUMBER:
336409060
ADMINISTRATOR:GARCIA, NOELIAFACILITY TYPE:
740
ADDRESS:2685 COTTAGE DRTELEPHONE:
(951) 898-8431
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:6CENSUS: 6DATE:
02/14/2023
UNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Noelia Garcia- LicenseeTIME COMPLETED:
12:37 PM
ALLEGATION(S):
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Licensee failed to insure resident personal information remained confidential.
Licensee failed to insure residents records were inaccessible.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ryan Gardner arrived at the facility unannounced to investigate and deliver findings for the above complaint allegations. LPA met with Licensee Noelia Garcia and explained the reason for the visit.

During today’s visit, LPA toured the facility and conducted interviews with staff.

For allegation, Licensee failed to insure resident personal information remained confidential:

During interviews conducted, LPA discovered that Resident R1’s records did not remain confidential in the facility. R1’s records were made available to a doctor visiting the facility. The doctor wrote down R1’s confidential information without the resident’s consent or the facilities consent. Due to this, the doctor falsely charged R1 for services that were never provided to R1.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
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 3
Control Number 18-AS-20210201151712
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: INSPIRATIONS HOME CARE III
FACILITY NUMBER: 336409060
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/21/2023
Section Cited
CCR
87506(c)(1)
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87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
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The licensee has agreed to read regulation 87506 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to conduct a resident confidential record training with staff and send LPA documentation of staff attendance to the training that includes the date and
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Based on interview, the licensee did not comply with the section cited above evidenced by R1’s records not being maintained confidential, records were revealed to an outside party, and R1 was charged for medical services without the resident’s consent which poses a potential health, safety, or personal rights risk to persons in care.
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signatures of each staff. The POC is due by 2/21/2023.
Type B
02/21/2023
Section Cited
CCR
87506(c)(1)
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87506 Resident Records (c) All information and records obtained from or regarding residents shall be confidential. (1) The licensee shall be responsible for storing active and inactive records and for safeguarding the confidentiality of their contents. The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative.
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The licensee has agreed to read regulation 87506 entirely and send LPA a self-certified letter that the regulation was read and understood. The licensee has agreed to conduct a resident records storage training with staff and send LPA documentation of staff attendance to the training that includes the date
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Based on interview, the licensee did not comply with the section cited above evidenced by R1’s resident records being on kitchen table instead of being stored in a centrally stored record location which poses a potential health, safety, or personal rights risk to persons in care.
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and signatures of each staff. The POC is due by 2/21/2023.
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: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210201151712
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: INSPIRATIONS HOME CARE III
FACILITY NUMBER: 336409060
VISIT DATE: 02/14/2023
NARRATIVE
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For allegation, Licensee failed to insure residents records were inaccessible.

During interviews conducted, LPA discovered that R1’s resident records were not stored in a central record location. LPA discovered that R1’s resident records were left accessible on the kitchen table instead of being stored in a centrally stored record location.

Based on the evidence gathered during today’s investigation, the two (2) allegations listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegations are valid because the preponderance of evidence the standard has been met.

During today’s visit, two (2) deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Licensee Noelia Garcia, along with a copy of the appeal rights.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3