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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209516
Report Date: 09/03/2025
Date Signed: 09/03/2025 06:39:55 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
08/25/2025 and conducted by Evaluator Daiquiri Boyd
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250825180500
FACILITY NAME:HIGH DESERT HAVENFACILITY NUMBER:
157209516
ADMINISTRATOR:POYTHRESS, LINDAFACILITY TYPE:
740
ADDRESS:1240 COLLEGE HEIGHTS BLVD.TELEPHONE:
(760) 371-1989
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:154CENSUS: 71DATE:
09/03/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Elizabeth VaskuTIME COMPLETED:
06:45 PM
ALLEGATION(S):
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Resident ingested another residents medication due to staff leaving medication accessible to other residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Daiquiri Boyd and Shawna Doucette conducted the 10 Day complaint investigation visit to the facility. During the course of this complaint investigation visit, LPAs interviewed staff and obtained and/or reviewed resident and facility records. It was determined based on the Incident Report submitted by the facility and records review that the above allegation is SUBSTANTIATED. Facility staff left medication accessible, allowing a resident (R1) access to another residents (R2) medications, and as a result R1 then injested medication that was prescribed for R2, requiring medical attention for R1. Based on LPAs records review and submitted reports, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.
California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
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 2
Control Number 24-AS-20250825180500
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: 157209516
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/04/2025
Section Cited
CCR
87465(a)(4)
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(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: (4) The licensee shall assist residents with self-administered
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Facility completed staff training on Medication Administration on 08/21/25. Proof of training was submitted to LPA Doucette on 9/3/25. POC cleared during visit.
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 medications as needed. This requirement is not met as evidenced by: staff left medication accessible during medication administration and R1 then injesting R2's medications resulting in R1 needing medical attention; which poses an immediate risk to the health, safety, or personal rights risk to the 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: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Daiquiri Boyd
LICENSING EVALUATOR SIGNATURE:

DATE: 09/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2