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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880940
Report Date: 05/13/2021
Date Signed: 10/21/2021 04:12:01 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
04/05/2021 and conducted by Evaluator Elecia Weathersby
COMPLAINT CONTROL NUMBER: 18-NP-20210405094823
FACILITY NAME:ENJOYCARE-PECANFACILITY NUMBER:
361880940
ADMINISTRATOR:BOLING, NIRMALA JOYFACILITY TYPE:
740
ADDRESS:11599 PECAN WAYTELEPHONE:
(909) 253-1355
CITY:LOMA LINDASTATE: CAZIP CODE:
92354
CAPACITY:6CENSUS: DATE:
05/13/2021
UNANNOUNCEDTIME BEGAN:
11:37 PM
MET WITH:Administrator, Joy BolingTIME COMPLETED:
11:47 PM
ALLEGATION(S):
1
2
3
4
5
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7
8
9
(10) Neglect/Lack of Supervision: Staff did not provide adequate care to resident.
(19) Other: Responsible party was not issued a refund in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elecia Weathersby contacted the facility via telephone to deliver findings regarding the above allegations. The unannounced contact was conducted via telephone due to COVID-19. LPA identified herself and discussed the findings of the above allegations with Administrator Boling.

Allegation #1 Neglect/Lack of Supervision: Staff did not provide adequate care to resident. Based on interviews and records review, this LPA was unable to corroborate the allegation. LPA could find no evidence that inadequate care was provided to the resident R1, the subject of this investigation. All interviewees denied neglect of R1 by facility staff. The allegation is therefore UNSUBSTANTIATED.

Continued on next page**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Elecia Weathersby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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-NP-20210405094823
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ENJOYCARE-PECAN
FACILITY NUMBER: 361880940
VISIT DATE: 05/13/2021
NARRATIVE
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Allegation #2 Other: Responsible party was not issued a refund in a timely manner.
Based on interviews and records review, this LPA was unable to corroborate the allegation. LPA could find no evidence that a refund was due to R1 or R1's responsible party as the signed admissions agreement indicated that a 30-day notice is required prior to discharging from the facility. RP and W1 confirmed that the admissions agreement was signed and initialed by R1's responsible party, prior to admission. The allegation is therefore UNSUBSTANTIATED.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Elecia Weathersby
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2