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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209068
Report Date: 02/19/2025
Date Signed: 02/20/2025 06:15:04 AM

Document Has Been Signed on 02/20/2025 06:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR/
DIRECTOR:		MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY: 82CENSUS: 70DATE:
02/19/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Administrator Linda PoythressTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility to conduct a complaint investigation. During the course of the investigation other deficiencies were observed.

During the course of interviews, it was revealed the call button is supposed to alert a staff cell phone, however the call system/cell phone is not properly working and is not alerting staff. Call light rings in front office, but cannot be heard in other wings of the facility. Call light is not operating properly. LPA took photos.

During the course of the investigation, LPA was informed there were cameras in resident rooms for staff and family to observe residents. LPA observed cameras in two rooms facing the residents beds. LPA observed the monitors on the staff desk for staff to observe residents in their rooms. LPA took photos of cameras and monitors.

Refer to 809D

A copy of this report with plan of corrections and appeal rights were emailed to the Administrator.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/20/2025 06:15 AM - It Cannot Be Edited


Created By: Shawna Doucette On 02/19/2025 at 01:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HIGH DESERT HAVEN
FACILITY NUMBER: 157209068

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/20/2025
Section Cited
CCR
87468.1(a)(3)

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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive
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POC Licensee agrees to immediately remove cameras out of resident rooms. Licensee agrees to submit in writing the understanding of this regulation by POC due date 02/20/25
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nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement was not met as evidenced by: Licensee having cameras in 2 out of 24 rooms for staff and family to view which poses an immediate health safety and or personal rights risk to residents in care.
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Type B
02/20/2025
Section Cited
CCR87303(i)(2)

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87303 (i) Facilities shall have signal systems which shall meet the following criteria: (2) Facilities having more than one wing, floor or building shall be permitted to have a separate system in each, provided each meets the above criteria. This requirement was not met
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 Licensee agrees to submit a plan on how the call ststem will be monitor until fixed due date 02/20/25. Licensee will submit proof of being fixed by 02/28/25.
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as evidenced by: R1's pendent was not working and LPA observed the call system in disrepair not alerting staff cell phone in other wings identifying which rooms need assistance, which poses an immediate heallth safety and or personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME:Alexandria Walton
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
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