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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 01:48:22 PM

Substantiated


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-20240910171129
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 TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff do not respond to requests for assistance in a timely manner.
Licensee is not ensuring that the facility has enough staff to meet the care needs of residents in care.
INVESTIGATION FINDINGS:
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On November 8, 2024, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez visited the facility to investigate the mentioned allegations and deliver findings. LPA met with Executive Director (ED) Monique Del Junco to discuss the purpose of the visit.

The investigation consisted of reviewing of files and interviewing relevant parties. The first allegation indicates that Staff do not respond to requests for assistance in a timely manner. Interviews with 5 residents revealed that more staff are needed because the response time was inconsistent. Interviews with five staff members revealed that more staff are needed, especially during the night shift and weekends. Staff mentioned that response times vary based on the need and if they are assisting residents who require more help. Staff also mentioned that when they are busy, response times can range from 30 to 45 minutes, which poses a health and safety risk to residents in care.

*** 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: 1 of 3
Control Number 56-AS-20240910171129
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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The second allegation indicates licensee is not ensuring that the facility has enough staff to meet the care needs of residents in care. Interviews with 5 residents stated that more staff is needed. Interviews with five staff members reported that more staff is needed. LPA Serrano also interviewed Resident Care Director (RCD) Jonnathan Rios and requested the facility's staff schedule. It was observed that weekend staff coverage 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 file reviews and interviews, the preponderance of evidence standard has been met, therefore, the allegations are substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 1).

An exit interview was conducted, where this report, LIC9099D along with appeal rights, was provided to the 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 3
Control Number 56-AS-20240910171129
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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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: 3 of 3