197608000-9-1-2022-31-AS-EMIR-CJ2PC5-20220907111123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608000
Report Date: 09/01/2022
Date Signed: 09/01/2022 07:15:08 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/14/2020 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20201214170752

FACILITY NAME:	A TOUCH OF PARADISE AT KENSINGTON		FACILITY NUMBER:	197608000
ADMINISTRATOR:	ELPIDIO TERMULO		FACILITY TYPE:	740
ADDRESS:	38954 KENSINGTON WAY		TELEPHONE:	(661) 236-7991
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	0	CENSUS: 0	DATE:	09/01/2022
		UNANNOUNCED	TIME BEGAN:	05:47 PM
MET WITH:			TIME COMPLETED:	05:48 PM

ALLEGATION(S):

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Medications are accessible.
Resident's have access to knives.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava generated this report to issue the findings regarding the above complaint allegations. Since receiving the complaint, the facility had closed on April 12, 2021. The 10-day visit was made by LPA Elizabeth Arambulo on December 24, 2020. The following are the investigative findings regarding both allegations.

Medications are accessible:
In regards to the allegation, on December 14, 2020, the Licensing office received a confidential report from a credible source alleging that during a visit on November 23, 2020, medications were observed in the kitchen drawer, unlocked and unattended. Medications were also observed in the refrigerator, left without a lock box and unattended. Per report received from the credible source, complaint is being reported due to multiple concerns regarding the residents' safety, pursuant to Health and Safety Code 1569.69. Based on the observation of this credible source, the allegation of medications are accessible is Substantiated. Citation issued on the 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

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 3

Control Number 31-AS-20201214170752

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A TOUCH OF PARADISE AT KENSINGTON	FACILITY NUMBER: 197608000
	VISIT DATE: 09/01/2022

NARRATIVE

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Residents have access to knives.
In regards to the allegation, on December 14, 2020, the Licensing office received a confidential report from a credible source alleging that during a visit on November 23, 2020, knives were observed left in the kitchen drawer, unlocked and unattended. Attempts were made to address this concern with the administrator, however, attempts were unsuccessful in reaching him. Multiple voicemail messages were left, but no call back. Per report received from the credible source, complaint is being reported due to concerns regarding the residents' safety, pursuant to Health and Safety Code. Based on the observation of this credible source, the allegation of residents having access to knives is Substantiated. Citation issued on the 9099D.

NOTE: Facility closed on 4/12/21. The address where facility was located no longer operates as an RCFE. This report is mailed to that address for the record. It is also emailed to the email address listed on facility file.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20201214170752

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: A TOUCH OF PARADISE AT KENSINGTON	FACILITY NUMBER: 197608000
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/01/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 09/01/2022 Section Cited CCR 87465(h)(2)	1 2 3 4 5 6 7	Incidental Medical and Dental Care: Centrally stored medicines shall be kept in a safe and locked place. This requirement has not been met as evidenced by a visit made to the facility on 11/23/20 by a credible source. It was observed that medications were unlocked and unattended in the kitchen	1 2 3 4 5 6 7	A POC cannot be issued at this time since the licensee had surrendered their license and facility has since closed on 4/12/21.
	8 9 10 11 12 13 14	drawer & refrigerator. This posses an immediate health and safety risk to the residents in care.	8 9 10 11 12 13 14
Type A 09/01/2022 Section Cited CCR 87309(a)	1 2 3 4 5 6 7	Storage Space: Items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement has not been met as evidenced by a visit made to the facility on 11/23/20 by a credible source. It was observed that knives were left unlocked and unattended	1 2 3 4 5 6 7	A POC cannot be issued at this time since the licensee had surrendered their license and facility has since closed on 4/12/21.
	8 9 10 11 12 13 14	in a kitchen drawer. This posses an immediate health and safety risk to the residents in care.	8 9 10 11 12 13 14

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: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 09/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022

LIC9099 (FAS) - (06/04)

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