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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881048
Report Date: 11/08/2024
Date Signed: 11/08/2024 01:31:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/10/2024 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20240910102504
FACILITY NAME:AQUA RIDGE OF MONTCLAIRFACILITY NUMBER:
361881048
ADMINISTRATOR:MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:9631 MONTE VISTA AVETELEPHONE:
(909) 483-2782
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:115CENSUS: 71DATE:
11/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Monique Del Junco, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff did not follow medication orders as prescribed
Due to staff neglect, resident developed a pressure injury
Staff did not ensure residents room was clean
Staff did not ensure residents hygiene needs were met
Staff did not ensure residents laundry was done timely
Due to lack of staff, medications were not administered timely
INVESTIGATION FINDINGS:
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On 11/08/2024 at 09:00 AM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility to deliver the findings of the above allegation. LPAs met with Executive Director Monique Del Junco and explained the purpose of the visit. The investigation consisted of file reviews, interviews with facility staffs and residents as well as observation.

Allegation: Staff did not follow medication orders as prescribed. Based on interviews conducted with 3 out of 5 residents they all stated that their medications are given as prescribed. Two (2) of the 5 residents were nonverbal and unable to communicate. Five staff persons were interviewed and 4 out of 5 reported that the medications are given as prescribed. One (1) staff person reported not having knowledge if medication was given as prescribed as they do not handle medications.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
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 5
Control Number 56-AS-20240910102504
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AQUA RIDGE OF MONTCLAIR
FACILITY NUMBER: 361881048
VISIT DATE: 11/08/2024
NARRATIVE
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Allegation: Due to staff neglect, resident developed a pressure injury. Based on staff interviews, and record review. Five (5) staff interviewed denied neglecting residents. Interviews revealed that if residents in care have pressure injuries, they are checked every two hours, and any concerns are reported to management, hospice, and resident family. Staff denied that residents are neglected but stated additional staff is needed.
Allegation: Staff did not ensure residents’ room was clean. Based on observation, record review, and interviews with facility staff and residents. All resident’s room are cleaned regularly as indicated in the staff cleaning schedule.

Allegation: Staff did not ensure residents hygiene needs were met. Based on observation, record review, and interviews with residents and facility they all deny that residents hygiene needs are not met. LPAs observed the residents showering schedule and there is no evidence to corroborate the allegation.

Allegation: Staff did not ensure residents’ laundry was done timely. Based on observation, record review, and interviews with residents and facility staff. The resident’s laundry is done timely and is documented in the staff’s laundry schedule.

Allegation: Due to lack of staff, medications were not administered timely. Based on record review and interviews with residents and facility staff. All resident’s medications are administered timely. There is no evidence to corroborate this allegation.

During the investigation, LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Executive Director Monique Del Junco.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
09/10/2024 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20240910102504

FACILITY NAME:AQUA RIDGE OF MONTCLAIRFACILITY NUMBER:
361881048
ADMINISTRATOR:MONIQUE DEL JUNCOFACILITY TYPE:
740
ADDRESS:9631 MONTE VISTA AVETELEPHONE:
(909) 483-2782
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:115CENSUS: 71DATE:
11/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Monique Del Junco, Executive DirectorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff did not safeguard residents personal property
Due to lack of supervision, resident had multiple falls resulting in injury
INVESTIGATION FINDINGS:
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On 11/08/2024 at 9:00 AM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez arrived at the facility to investigate a complaint and deliver the findings for the above complaint allegation. Upon arrival, LPAs met with Executive Director (ED) Monique Del Junco, and LPAs discussed the purpose of the visit. The investigation consisted of file review and interviews with facility staff and relevant parties.

Allegation: Staff did not safeguard residents’ personal property. Based on the interview with Resident Care Director (RCD) Jonnathan Rios, resident #3 (R3) clothes were taken by a wandering resident but later recovered and returned to R3’s room. RCD also mentioned that they installed latches on resident’s closet so wanderers cannot take clothes from another resident. Per interviews, LPA noted that facility did not safeguard the residents’ personal property.

*** Continuation in LIC9099C ***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20240910102504
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: AQUA RIDGE OF MONTCLAIR
FACILITY NUMBER: 361881048
VISIT DATE: 11/08/2024
NARRATIVE
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Allegation: Due to lack of supervision, resident had multiple falls resulting in injury. - Based on interview and record review, Staff indicated that there’s not enough staff working in memory care to provide sufficient supervision. LPA Serrano also interviewed Resident Care Director (RCD) Jonnathan Rios and requested the facility's staff schedule. It was observed that staff coverage on the weekends is less than during the weekdays. RCD mentioned that new staff are in training and will be ready to work once their training is complete.

Based on LPAs observations and interviews and records review conducted, the preponderance of evidence standard has been met, therefore, the allegation of Staff did not safeguard residents’ personal property and Due to lack of supervision, resident had multiple falls resulting in injury are SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 6 is being cited on the attached LIC9099D.

An exit interview was conducted where this report (LIC 9099), LIC9099D, and Appeal Rights were discussed and provided to Executive Director Monique Del Junco.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20240910102504
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: AQUA RIDGE OF MONTCLAIR
FACILITY NUMBER: 361881048
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2024
Section Cited
CCR
87411(a)
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87411(a) - PERSONNEL REQUIREMENTS - GENERAL (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...This requirement is not met as evidenced by:
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The licensee agreed to hire more staff and provide CCL with an update current staff schedule with sufficient staffing to meet the needs of the resident 7 days a week and provide proof of schedule on plan of correction (POC) due date.
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 Based on records review, interviews with residents and staff; the licensee did not ensure there is enough staff on schedule to meet the needs of the residents.
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Under Appeal
Type B
11/08/2024
Section Cited
CCR
87217(b)
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87217(b) Safeguards for Resident Cash, Personal Property, and Valuables.(b) Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. The licensee shall give the residents receipts for all such articles or cash resources.
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LIcensee agreed to submit proof of an installed latch in the closet to prevent other residents from taking properties of another resident on plan of correction (POC) due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 11/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5