374601420-9-21-2022-18-AS-DMUN-CJHVB5-20220922161657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601420
Report Date: 09/21/2022
Date Signed: 09/21/2022 11:31:41 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, 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
09/16/2022 and conducted by Evaluator Tricia Danielson

COMPLAINT CONTROL NUMBER: 18-AS-20220916111931

FACILITY NAME:	EAGLES NEST RETIREMENT RANCH IV		FACILITY NUMBER:	374601420
ADMINISTRATOR:	RICHLEY, MARIA C.		FACILITY TYPE:	740
ADDRESS:	2113 DREW ROAD		TELEPHONE:	(760) 415-1252
CITY:	ESCONDIDO	STATE: CA	ZIP CODE:	92027
CAPACITY:	6	CENSUS: 4	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Maria Richley, Administrator		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

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9

Staff did not get medical attention timely for resident
Staff are not following Physician's orders
Staff did not tell authorized representative of change in resident's condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegations list above. LPA met with Administrator Maria Richley and explained the purpose of today's visit.
The allegations of this complaint concern Resident #1 (R1). During today's visit, it was discovered that R1 does not reside at this facility but rather, resides at a facility two houses away with a very similiar address.
Therefore, the allegations list above are UNFOUNDED. This agency has investigated the complaint alleging "Staff did not get medical attention timely for resident", "Staff are not following Physician's orders", and "Staff did not tell authorized respresentative of change in resident's condition". We have found that the complaint was unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis.
An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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