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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366413080
Report Date: 09/21/2023
Date Signed: 09/21/2023 09:38:05 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/17/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200317145122
FACILITY NAME:TUPARAN RESIDENTIAL CARE FACILITY INCFACILITY NUMBER:
366413080
ADMINISTRATOR:TUPARAN, LORETAFACILITY TYPE:
740
ADDRESS:1929 CHURCH STREETTELEPHONE:
(909) 307-1273
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:6CENSUS: 0DATE:
09/21/2023
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Loreta Tuparan, LicenseeTIME COMPLETED:
09:20 AM
ALLEGATION(S):
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Facility did not notify the responsible person of a change of condition for the resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson met with Licensee Loreta Tuparan via telephone to conclude an investigation into the allegation listed above. The facility does not currently have residents and there are mitigating circumstances that deem Ms. Tuparan to be unable to meet with LPA at the facility.
Regarding the allegation "Facility did not notify the responsible person of a change of condition for the resident", it was alleged that the facility did not notify Resident #1's (R1's) responsible person that R1's eyes were swollen and gooey and having trouble walking as noted on R1's last day at the facility. Interview with Licensee Tuparan indicated no notice was made to anyone because there had not been any change in R1's condition. Tuparan stated R1 had been on a visit with their sister three (3) days prior to their last day at the facility and R1's sister did not report any concerns. Interview with R1's responsible person/Power of Attorney (POA) confirmed R1 was visited three (3) days prior to leaving the facility and R1's eyes appeared normal and was able to walk without difficulty however, on R1's last day, these changes were observed but no one from the facility had reported them to the responsible person/POA. R1 passed away and was unable to be interviewed. Review of R1's POA documentation revealed the authority of the POA was (CONTINUED ON LIC9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023
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 18-AS-20200317145122
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: TUPARAN RESIDENTIAL CARE FACILITY INC
FACILITY NUMBER: 366413080
VISIT DATE: 09/21/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
for financial powers only and did not include a Health Care Proxy therefore the facility had no obligation to notify R1's financial responsible party/POA of a change in R1's condition. The facility was unable to provide any documentation regarding R1.
This agency has investigated the complaint alleging "Facility did not notify the responsible person of a change of condition for the resident". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list was provided.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2