<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336409083
Report Date: 08/05/2024
Date Signed: 08/29/2024 09:55:35 AM

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
08/17/2021 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20210817103910
FACILITY NAME:VANDELON HOMECARE, INC.FACILITY NUMBER:
336409083
ADMINISTRATOR:MARLON UYFACILITY TYPE:
740
ADDRESS:1335 E. WHITTIER AVETELEPHONE:
(951) 791-0061
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:6CENSUS: 5DATE:
08/05/2024
UNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Bernardo Lazo - CaregiverTIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained pressure injuries while in care
Staff is verbally abusive to resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegations listed above. LPA met with caregiver Bernardo Lazo and explained the purpose of the visit.

Regarding allegation “Resident sustained pressure injuries while in care” it was reported Resident One (R1) had sustained bed sores due to Staff One (S1) not rotating client frequently. Training records for S1 reveal S1 has completed their twenty (20) Hour Annual Caregiver training on 01/29/2021 and completed two (2) hours of “Hospice Care: Turning and Skin Breakdown” on 01/12/2021. Interview with S1 revealed R1 did not have a pressure wound but a rash on her back and buttocks area. R1 was rotated every two hours. Interview with staff reported R1 had to be rotated and if there was a change in R1’s condition they would notify hospice. Interview with (4) staff reported R1 did not have a pressure injury. Interview with hospice nurse reported R1 did not have pressure wounds but had rashes on their back and buttocks area that is improving.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
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 2
Control Number 18-AS-20210817103910
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: VANDELON HOMECARE, INC.
FACILITY NUMBER: 336409083
VISIT DATE: 08/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Records review of Pacific Valley Hospice Care Physician’s Orders dated 07/09/2021 documents a new treatment order for R1 regarding a lower back and buttock rash. Records review of R1’s Hospice Sign In Log reveals hospice LVN nurse had a scheduled visit with R1 twice a week since hospice admission date 06/01/2021. Therefore based on interviews and records review the allegation “Resident sustained pressure injuries while in care” has been deemed Unfounded

Regarding the allegation “Staff is verbally abusive to resident”, it was reported S1 has been verbally abusive to R1. Interview with R1 revealed they have not been yelled at or verbally abused by S1 or other staff members at the facility. Interview with three (3) residents denied allegation of S1 being verbally abusive or yelling at residents. Interview with four (4) staff denied allegation of S1 being verbally abusive or yelling at residents. Interview with S1 reported they were not verbally abusive to R1 and they did not yell at R1. S1 reported to have a loud voice but they would not yell at residents. Therefore the allegation has been deemed Unfounded at this time.

This agency has investigated the complaint allegations listed above. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided to caregiver Lazo
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Sara Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2