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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880964
Report Date: 02/13/2023
Date Signed: 02/13/2023 01:45:37 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2023 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20230209115240
FACILITY NAME:CADENCE AT RANCHO CUCAMONGAFACILITY NUMBER:
361880964
ADMINISTRATOR:PENDINGFACILITY TYPE:
740
ADDRESS:10459 CHURCH STREETTELEPHONE:
(909) 918-5546
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:117CENSUS: 74DATE:
02/13/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Gen Diaz, Business Office DirectorTIME COMPLETED:
01:55 PM
ALLEGATION(S):
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Staff are not following COVID protocol
Staff are not meeting the needs of COVID Positive residents
Due to insufficient staffing, residents are not being served meals timely
Due to insufficient staffing, residents are not being assisted with feeding in a timely manor
Due to insufficient staffing, residents are not being assisted with toileting timely

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPAs) Javier Prieto and Magda Malcore arrived at the facility to conduct a complaint investigation regarding the above mentioned allegations. LPAs met with Gen Diaz, Business Office Director.
Upon arrival LPAs observed facility following COVID protocols. LPAs temperatures were taken, facility has proper PPE stations and sanitizing solutions throughout the facility. Focus on COVID positive protocols were met by dedicated staff assigned to COVID positive residents. LPAs observed proper PPE and sanitation stations outside the isolation ward.

Interviews with staff #1 (S1), S2, S3, S4, S5 along with Resident #1 (R1), R2, R3 reveal that resident’s meals are being served in a timely manner, assisted with feeding in a timely manner, assisted with toileting in a timely manner.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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 2
Control Number 56-AS-20230209115240
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
, CA 92507
FACILITY NAME: CADENCE AT RANCHO CUCAMONGA
FACILITY NUMBER: 361880964
VISIT DATE: 02/13/2023
NARRATIVE
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Based on the information obtained there is not enough evidence that staff are not following COVID protocol, staff are not meeting the needs of COVID Positive residents, residents are not being served meals in a timely manner due insufficient staffing, residents are not being assisted with feeding in a timely manor due to insufficient staffing, residents are not being assisted with toileting in a timely manner. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2