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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209068
Report Date: 03/25/2025
Date Signed: 03/25/2025 05:39:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
01/10/2025 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20250110101733
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR:MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:82CENSUS: 75DATE:
03/25/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Linda PoythressTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff verbally abuse residents in care
Residents were not accorded dignity in their perosnal relationships with staff
Staff do not provide assistance in meeting resident medical needs
Staff do not answer resident calls for assistance
Staff do not have the knowledge to recognize and respond to problems
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA)'s Shawna Doucette and Kamaldeep Kaur arrived at the facility unannounced to conduct an investigation regarding the allegations listed above. LPA was granted into the facility by the Administrator. LPA met with Administrator Linda Poythress.

Based on Interviews, regarding the allegations Staff verbally abuse residents in care and Residents were not accorded dignity in their perosnal relationships with staff, S5 spoke inappropriately to residents on multiple occasions, using profanity towards residents while changing residents. Administrator and Care Coordiantor were notified of the incidents.

Based on interviews and observation, regarding allegation Staff do not provide assistance in meeting resident medical needs it was found facility staff did not seek medical attention for 3 out of 5 residents who developed a rash that started in November 2024 with R4 and R5. The rash spread to residents and staff. The rash was not diagnosed until February 2025.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
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 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
01/10/2025 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20250110101733

FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209068
ADMINISTRATOR:MATHEW, ABRAHAMFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVDTELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:82CENSUS: 75DATE:
03/25/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Linda PoythressTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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9
Staff not administering medications as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA)'s Shawna Doucette and Kamaldeep Kaur arrived at the facility unannounced to conduct an investigation regarding the allegations listed above. LPA was granted into the facility by the Administrator. LPA met with Administrator Linda Poythress.

Based on interview and records review, medications are being administered as prescribed. LPA reviewed PRN’s for Morphine and Lorazepam. Medications were found to be logged and administered appropriately.

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, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20250110101733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: HIGH DESERT HAVEN
FACILITY NUMBER: 157209068
VISIT DATE: 03/25/2025
NARRATIVE
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Based on photos, observation, records review and interviews, facility call light is inoperable for facility staff to respond to residents. On February 19, 2025, LPA reviewed the call light system screen, and the screen showed Room 135 waiting 29 minutes, Room 106 and Room 126 waiting 2 hours. During today’s visit, call light are currently not working properly, so Administrator called over radio for staff to respond when LPA Kaur pulled the call light for Room 107. Staff responded in 14:42 minutes. LPA interviewed staff and based on interviews when there are 3 caregivers on shift there is enough staff but when there are two caregivers on shift there is not enough staff to meet the needs of the residents. LPA reviewed staff schedule and observed several days with only two caregivers on shift.

Based on records review and interviews, it was found staff do not have the knowledge to recognize and respond to problems. R6 had blood sugar readings in between 300 to 560 with no restricted health care plan indicating when R6 should be sent to the hospital. LPA obtained copies of the blood sugar readings from 11/24/24 to 12/28/24.

Based on interviews, records review, observation and photos, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.



An exit interview was conducted and a copy of this report along with appeal rights and plan of correction were provided.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20250110101733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HIGH DESERT HAVEN
FACILITY NUMBER: 157209068
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/26/2025
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 nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
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Plan of Correction Licensee agrees to conduct a personal rights and elder abuse training by POC due date 3/26/25.
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This requirement was not met as evidenced by: Licensee did not ensure residents were free from humiliation when S5 spoke inappropriately to residents on multiple occasions, using profanity towards residents while changing residents which poses an immediate health safety and or personal rights risk.
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Type A
03/26/2025
Section Cited
CCR
87465(a)(1)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.
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Licensee agrees to submit a written statement on how this regulation will be met by POC due date 3/26/25
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This requirement was not met as evidenced by: Licensee did not ensure 3 out of 5 residents received medical care timely for a rash which poses an immediate health and safety risk.
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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.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20250110101733
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HIGH DESERT HAVEN
FACILITY NUMBER: 157209068
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/26/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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Licensee agrees to submit a staffing plan that will meet the needs of the residents by POC due date 3/26/25.
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This requirement was not met as evidenced by: Facility staff did not respond to a call light for 14:42 minutes today. On February 19, 2025, the call light screen showed Room 135 waiting 29 minutes, Room 106 and Room 126 waiting 2 hours, which poses an immediate health safety and or personal rights risk to residents in care.
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Type A
03/26/2025
Section Cited
CCR
87466
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87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.
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Licensee agrees to conduct a training and will submit a plan with scheduled training date by POC due date 3/26/25
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This requirement was not met as evidenced by: Licensee did not have a restricted health care plan to indicate when R6 should be sent to the hospital once blood sugar reaches a high level which poses an immediate health 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.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 03/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5