361880919-8-26-2024-56-AS-EMAN-DEYTH6-20250321144413

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880919
Report Date: 08/26/2024
Date Signed: 08/26/2024 11:51:48 AM

Unsubstantiated

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
03/08/2024 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240308121331

FACILITY NAME:	LOVE 2 CARE HOMES		FACILITY NUMBER:	361880919
ADMINISTRATOR:	JACKSON, TERRI		FACILITY TYPE:	740
ADDRESS:	19432 US HIGHWAY 18		TELEPHONE:	(760) 297-6277
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92307
CAPACITY:	6	CENSUS: 3	DATE:	08/26/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Eula Jones		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Administrator changed resident's advanced directive without authorized representatives consent
Staff are mismanaging resident's medication
Staff are not meeting resident's needs
Staff are not providing activities for residents
Staff are not conducting quarterly emergency drills
Staff are not providing adequate food service to residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with care giver Eula Jones and contacted the Administrator Terri Jackson by a phone call. LPA explained the purpose of the visit. The investigation consisted of staff interviews, resident interviews and record review.

For the allegation, Administrator changed resident's advanced directive without authorized representatives consent.

During staff interviews 2 out of the 3 staff stated Administrator did not change R1 advanced directive. 1 out of the 3 staff stated they did not change resident advanced directive without representative consent. In addition, 1 out of the 3 staff informed LPA that R1 was in year 2023 R1 was in hopsice. By the year 2024 R1 was discharge from hospice.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

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 56-AS-20240308121331

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: LOVE 2 CARE HOMES	FACILITY NUMBER: 361880919
	VISIT DATE: 08/26/2024

NARRATIVE

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During record review, R1 LIC627C authorizes the facility to make decisions for the resident during an emergency, signed by authorized representative. Furthermore, no sufficient documents to collaborate the alleged allegation.

For the allegation, Staff are mismanaging resident's medication.

During staff interviews 3 out of the 3 staff stated they have not mismanaged resident’s medication. During resident interview 2 out of the 3 resident stated they receive their medication. During medication audit, LPA observed medication dispensed properly.

For the allegation, Staff are not meeting resident's needs.

During staff interviews, 3 out of the 3 staff stated they are trained to meet each resident care plan. During residents 2 out of the 3 residents stated staff will assist with their ADLs.

For the allegation, Staff are not providing activities for residents.

During staff interviews, 3 out of the 3 staff stated activities are provided to all residents. 2 out the 3 residents stated staff provide activities in the morning and afternoon. 1 out of the 3 resident informed LPA they do not like to participate in activities. During record review, LPA received a copy of facility’s activity calendar.

For the allegation, Staff are not conducting quarterly emergency drills.

During staff interviews, 3 out of the 3 staff stated they are provided with emergency drills thought out the year. LPA received a copy of facility’s quarterly emergency drills.

For the allegation, Staff are not providing adequate food service to residents.

During staff interviews, 3 out of the 3 staff stated adequate food is provided to all residents. During residents’ interviews 3 out of the 3 residents stated they enjoy their meals. During facility tour LPA observed adequate food, LPA also received a copy of facility’s menu.

Based on the evidence found during the investigation, the six (6) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report (LIC9099) was discussed and provided Eula Jones.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2024

LIC9099 (FAS) - (06/04)

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