157209068-12-5-2022-24-AS-MHON-CMSM5Y-20230105081908

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209068
Report Date: 12/05/2022
Date Signed: 12/05/2022 02:08:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20221201143337

FACILITY NAME:	HIGH DESERT HAVEN		FACILITY NUMBER:	157209068
ADMINISTRATOR:	MATHEW, ABRAHAM		FACILITY TYPE:	740
ADDRESS:	1240 COLLEGE HEIGHTS BLVD		TELEPHONE:	(760) 371-1989
CITY:	RIDGECREST	STATE: CA	ZIP CODE:	93555
CAPACITY:	82	CENSUS: 75	DATE:	12/05/2022
		UNANNOUNCED	TIME BEGAN:	11:57 AM
MET WITH:	Janice Johnson		TIME COMPLETED:	02:28 PM

ALLEGATION(S):

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Staff not providing medications as prescribed to resident(s) in care.

INVESTIGATION FINDINGS:

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On 12/05/22, Licensing Program Analysts (LPAs) M. Medina and L. Salazar arrived at the facility unannounced to conduct a 10-day complaint visit. LPA was met my Janice Johnson, Administrative Assistant and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

During the course of the investigation, LPA conducted interviews, conducted record review of Resident (R1's) file and Centrally stored medication.

Based on interviews conducted and records review, the allegation of staff not providing medications as prescribed to resident(s) in care is UNSUBSTANTIATED. 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.

No deficiencies cited during this complaint visit. An exit interview was conducted. A copy of this report was discussed and provided to facility staff, Janice Johnson for facility records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 12/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2022

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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