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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413083
Report Date: 07/22/2021
Date Signed: 07/22/2021 12:33:59 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/18/2020 and conducted by Evaluator Elecia Weathersby
COMPLAINT CONTROL NUMBER: 18-AS-20200818094045
FACILITY NAME:GEM'S SENIOR LIVING IIFACILITY NUMBER:
336413083
ADMINISTRATOR:GERLITA HIGAFACILITY TYPE:
740
ADDRESS:28291 PORTSMOUTH DRIVETELEPHONE:
(951) 301-4134
CITY:SUN CITYSTATE: CAZIP CODE:
92586
CAPACITY:6CENSUS: DATE:
07/22/2021
UNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Administrator, Gerlita HigaTIME COMPLETED:
12:32 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff was under the influence of alcohol while providing care and supervision to residents while in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst's (LPA's) Elecia Weathersby and Melody Brown made an unannounced visit to the facility for the purpose of investigating a complaint with the above allegations. LPA's met with facility Administrator Gerlita Higa and explained the purpose of the inspection. Below is a summary of the findings of the investigation:

Allegation #1:Staff was under the influence of alcohol while providing care and supervision to residents while in care:
LPA's Elecia Weathersby and Melody Brown conducted a tour of the inside and outside of the facility, specifically checking trash cans, recycling, cabinets and refrigerator to see if there was any evidence of alcohol. LPA Weathersby additionally conducted a quick inspection of resident rooms, accompanied by Administrator Gerlita Higa. There was no signs of alcohol. 4 of 6 residents were interviewed, and 2 of 2 staff were interviewed. There was insufficient evidence to confirm the allegation, or dismiss it. Based on LPA's Weathersby and Brown's observations and interviews, the allegation is UNSUBSTANTIATED. A finding of Unsubstantiated means 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.

A copy of this report and appeals right were reviewed with and provided to Administrator, Gerlita Higa at the end of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Elecia Weathersby
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2021
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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