Inspection Reports for
Summerfield Memory Care of Redlands

The visit was related to complaint control numbers 56-AS-20250905080217 and 56-AS-20250818130125. The amended report on the first complaint was delivered during this visit.

The Licensing Program Analyst toured the facility, conducted interviews, and assessed pertinent documents related to complaint investigations. The report was discussed in an exit interview with the Business Office Manager.

During the visit, interviews with staff were conducted, facility records were reviewed, and relevant documents were collected to assist with the investigation. No deficiencies were cited during the visit.

The complaint alleged that a resident sustained bruising due to an unknown cause. The investigation was unsubstantiated, meaning there was insufficient evidence to prove the alleged violation did or did not occur.

The investigation included interviews with staff, review of facility and medical records, and found that although bruising was observed on the resident, the exact source could not be determined. Therefore, the allegation was unsubstantiated due to lack of preponderance of evidence.

The complaint alleged that staff did not properly supervise a resident, resulting in a fall. The allegation was deemed unsubstantiated based on the investigation findings.

The investigation found insufficient evidence to substantiate the allegation that staff failed to properly supervise the resident resulting in a fall. The resident was independent in toileting and ambulation, and the fall was documented with appropriate follow-up and reporting.

The visit was triggered by a complaint or unusual incident report; no deficiencies or substantiated issues were found.

No health and safety concerns were observed during the visit and no deficiencies were cited.

The complaint control number 56-AS-20251001084626 was investigated, and the finding was unsubstantiated.

The allegation that staff did not provide adequate supervision resulting in residents engaging in physical altercations due to staff shortage was found to be unsubstantiated.

The Licensing Program Analyst arrived to have the Resident Services Director sign the amended complaint investigation report. The report was signed by both parties and a copy was left with the facility.

The report documents the signing of an amended Complaint Investigation Report by the Resident Services Director and Licensing Program Analyst. No specific deficiencies or findings are detailed in this report.

The facility was found to be in compliance with all applicable regulations with no deficiencies cited. The physical plant, food service, care and supervision, medical related services, and record reviews were all satisfactory.

The facility was found to be in compliance with no deficiencies cited. The physical plant, food service, care and supervision, medical related services, and record reviews met regulatory standards.

The complaint involved allegations that facility staff did not know a resident's whereabouts for an extended period, a resident did not receive assistance after falling for an extended period, and a resident sustained injuries (sun/heat blisters, head wound) while in care. The investigation concluded these allegations were unsubstantiated.

The investigation found no evidence to support the allegations. Interviews with staff and residents indicated sufficient staffing and awareness of resident whereabouts. Documentation showed timely response to a resident fall with no evidence of prolonged neglect or injury related to the complaint. The allegations were deemed unsubstantiated.

The visit was related to a complaint investigation identified by Complaint Control Number 56-AS-20220310135429. The report documents the signing of an amended complaint report but does not state substantiation status.

The Licensing Program Analyst arrived to conduct additional interviews and obtained signatures on an amended complaint report. No specific deficiencies or violations were detailed in the report.

The complaint was unsubstantiated based on investigation findings. Allegations included staff not knowing resident whereabouts, delayed assistance after a fall, and resident injuries. Interviews and documentation did not corroborate these claims.

The investigation found no evidence to support the allegations. Interviews with staff and residents indicated sufficient staffing and awareness of resident whereabouts. Documentation showed the resident in question was transferred to a medical facility after a fall, with no evidence of prolonged lack of assistance or injuries related to care. The allegations were deemed unsubstantiated.

The visit was related to Complaint Control Number 56-AS-20220310135429. The amended complaint report was signed by the Licensing Program Analyst and the Executive Director.

The Licensing Program Analyst arrived to conduct additional interviews and to have the Executive Director sign the amended complaint report. The amended report was signed and a copy was left at the facility.

The complaint investigation was unsubstantiated, meaning there was not enough evidence to prove the alleged violations occurred.

The investigation found all allegations to be unsubstantiated. The facility was observed to follow reporting requirements, was sufficiently staffed, and staff were properly trained. Residents interviewed were unable to respond due to cognitive impairment.

The complaint investigation was unsubstantiated, meaning there was not enough evidence to prove the alleged violations occurred. Allegations included unexplained injuries to residents, failure to follow reporting requirements, insufficient staffing, and improper staff training.

The investigation found all allegations to be unsubstantiated based on observations, interviews, and record reviews. The facility was found to follow reporting requirements, be sufficiently staffed, and have properly trained staff. Residents were unable to respond due to cognitive impairment.

Complaint was unsubstantiated. Although the allegation may have been valid, there was not a preponderance of evidence to prove the alleged violation did or did not occur.

The investigation found that Resident #1 was being treated for a stage 2 pressure injury and was repositioned every two hours according to the treatment plan. Interviews with staff and residents indicated consistent staff support and no concerns regarding care. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.

The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred. The allegations involved pressure injury development and unmet resident care needs.

The investigation found that Resident #1 was being treated for a stage 2 pressure injury and an elbow skin tear under hospice care, with prescribed medication and repositioning every two hours as per the treatment plan. Interviews with staff and residents indicated consistent staff support and no concerns about care, leading to the determination that the allegations were unsubstantiated.

The facility was found to be operating within its licensed capacity, clean, in good repair, and maintaining safe conditions. No deficiencies were cited during the inspection, and all reviewed resident and staff files were in order.

The facility was found to be operating within its licensed capacity, clean, in good repair, and safe for residents. No deficiencies were cited during the inspection.

The facility was found to be clean, in good repair, and operating in safe conditions with no deficiencies cited. Inspections included facility premises, kitchen, client bedrooms, shower rooms, safety equipment, medication storage and administration, staff and client records.

The facility was found to be clean, in good repair, and operating in safe conditions for clients in care. No deficiencies were cited during the visit. All inspected areas including client bedrooms, kitchen, medication storage, and safety equipment were compliant with state and federal requirements.

The complaint alleged that facility staff handled Resident #1 roughly, resulting in injuries. The investigation included review of medical records, facility files, reports, and interviews. The allegation was unsubstantiated due to lack of evidence.

The investigation found no preponderance of evidence to support the allegation that facility staff handled the resident roughly. X-rays showed a right-hand fracture, but the circumstances and timing were not supported by witnesses or documentation. The allegation was determined to be unsubstantiated.

The complaint alleged that facility staff handled Resident #1 roughly, resulting in injuries. The investigation included review of medical records, facility files, reports, and interviews. The allegation was found unsubstantiated due to insufficient evidence.

The investigation found the allegation unsubstantiated due to lack of evidence and witness support. Although a right-hand fracture was diagnosed, there was no documentation or reports to confirm the alleged incident occurred as stated.

The complaint investigation was unsubstantiated, meaning although the allegations may have happened or be valid, there was not a preponderance of evidence to prove the alleged violations did or did not occur.

After reviewing documents, interviewing staff and residents' responsible parties, and observing records, the allegations were found to be unsubstantiated as there was insufficient evidence to prove the alleged violations occurred.

The complaint investigation was unsubstantiated, meaning there was not a preponderance of evidence to prove the alleged violations occurred. The four allegations investigated were: 1) noncompliance with bathing and hygiene agreements, 2) failure to meet residents' needs resulting in bed sores, 3) failure to inform POA of medical condition changes, and 4) inadequate nutritional meals causing weight loss.

The investigation included document reviews, interviews with twelve staff members and six residents' responsible parties, and observation of resident records. The findings determined that staff were following bathing and hygiene agreements, meeting residents' needs by contacting responsible parties and physicians, and notifying them of changes in medical conditions. All four allegations were deemed unsubstantiated due to insufficient evidence.

The complaint investigation was unsubstantiated. Allegations included unmet hygiene needs, unclean bathrooms, malodorous rooms, withholding of personal items, and failure to provide a rate change notice. Interviews and observations did not support these claims.

Based on interviews with staff and outside parties, observations of the facility, and records reviewed, all six allegations were deemed unsubstantiated as there was insufficient evidence to prove the alleged violations occurred.

The visit was related to complaint number 56-AS-20220921101913. No substantiation status or further complaint details are provided.

The report documents the signing of complaint-related forms for complaint number 56-AS-20220921101913 on 01/04/2023. No specific findings or deficiencies are detailed in the report.

The visit was related to complaint number 56-AS-20220921101913. No substantiation status or further complaint details are provided.

The report indicates that the LIC9099 and LIC9099-C forms for the referenced complaint were signed on 01/04/2023. No further findings or deficiencies are detailed in the report.

The complaint investigation was unsubstantiated. Allegations included unmet hygiene needs, unclean clothing, unclean bathroom, malodorous rooms, withholding of personal items, and failure to provide a 60-day rate change notice. Interviews and observations did not support these claims.

Based on interviews with staff and outside parties, observations of the facility and residents, and records reviewed, all six allegations were found to be unsubstantiated with no preponderance of evidence to prove the alleged violations occurred.

The facility was observed to have proper infection control measures including signage, hand hygiene supplies, cleaning provisions, and PPE use. No deficiencies were cited during the inspection.

The facility was observed to have proper infection control measures including signage, hand hygiene supplies, cleaning provisions, and proper use of face coverings. No deficiencies were cited during the inspection.

The complaint was unsubstantiated based on the investigation findings that refuted the allegations of no administrator, overmedication, and lack of staff.

The investigation found that the Executive Director has been in position for over three years with a designated substitute, medication administration records showed no discrepancies or overmedication, and the facility was fully staffed with residents and staff confirming adequate care. Therefore, the allegations were deemed unsubstantiated.

The complaint was unsubstantiated based on the investigation findings that disproved the allegations of no Administrator/Executive Director, overmedication, and lack of staff.

The investigation found that the Executive Director has been in position for over three years with a designated substitute, medication administration records showed no discrepancies or overmedication, and the facility was fully staffed with residents and staff confirming adequate care. Therefore, the allegations were deemed unsubstantiated.

The complaint investigation was unsubstantiated based on interviews with multiple staff members and the resident, as well as observations made during the visit.

The Licensing Program Analyst conducted interviews with staff and the resident, toured the facility, and found no evidence of injuries or lack of care. The facility was clean and free from clutter. The allegation was deemed unsubstantiated due to insufficient evidence.

The complaint was unsubstantiated after investigation. Staff interviews and resident assessment did not reveal any injuries or concerns related to the allegation.

The Licensing Program Analyst interviewed staff and the resident, toured the facility, and found no evidence of injuries or lack of care. The facility was clean and free from clutter. The allegation was deemed unsubstantiated due to insufficient evidence.

The complaint investigation was unsubstantiated due to lack of sufficient evidence to prove the alleged violations occurred.

The investigation found the facility to be clean and free of obstructions, with sufficient staff and proper documentation for residents. There was not enough evidence to substantiate the allegations, and the complaint was deemed unsubstantiated.

The complaint investigation was unsubstantiated based on the evidence gathered. Allegations included untimely resident changes, missing physician reports, lack of Hoyer lift, missing medication lists, untimely showers, and insufficient staffing. The evaluator found no preponderance of evidence to prove violations.

The investigation found the facility to be clean and free of obstructions, with sufficient staff and proper documentation for residents. There was not enough evidence to substantiate the allegations, and therefore all allegations were deemed unsubstantiated.

The complaint investigation was unsubstantiated. Allegations included neglect resulting in death, inadequate staffing, temperature issues, uncleared adults working, and lack of signaling systems. Evidence did not support these allegations.

The investigation found all allegations to be unsubstantiated based on interviews, observations, and records review. The resident's death was attributed to COPD complications with no evidence of neglect. Staffing levels were adequate, temperature was maintained comfortably, all staff were properly cleared, and resident rooms had signaling systems.

The complaint investigation was unsubstantiated. Allegations included neglect resulting in death, inadequate staffing, temperature issues, uncleared adults working, and lack of signaling systems. Evidence did not support these allegations.

The investigation found all allegations to be unsubstantiated based on interviews, records review, direct observation, and staff schedules. The resident's death was attributed to COPD complications with no evidence of neglect. Staffing levels were adequate, temperature was maintained comfortably, all staff were properly cleared, and resident rooms had signaling systems.

The complaint investigation was unsubstantiated. Allegations included residents left in urine and feces-soaked diapers for extended periods, staff not provided adequate personal protective equipment, and residents' clothing not changed daily. Interviews with staff and review of records did not support these allegations.

The investigation included interviews and record reviews which found that staff are required to check and change residents' diapers regularly, adequate personal protective equipment is provided and mandatory for staff, and residents' clothing is changed daily or as needed. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.

The complaint involved allegations of a questionable death of Resident #1 due to neglect and that the resident developed pressure injuries while in care. The investigation included review of medical records, interviews, and facility file review. The questionable death allegation was found to be unfounded, and the pressure injury allegation was unsubstantiated.

The investigation found the allegation of questionable death to be unfounded with no evidence of neglect by facility staff. The allegation regarding pressure injuries was unsubstantiated, meaning there was insufficient evidence to prove neglect caused the injuries.