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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609956
Report Date: 09/30/2021
Date Signed: 09/30/2021 03:03:59 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, 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
09/23/2021 and conducted by Evaluator Joscelyn Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210923114605
FACILITY NAME:DESERT WILLOW HOMEFACILITY NUMBER:
197609956
ADMINISTRATOR:LOPEZ, MONIQUEFACILITY TYPE:
735
ADDRESS:4125 W AVENUE DTELEPHONE:
(805) 544-5332
CITY:LANCASTERSTATE: CAZIP CODE:
93536
CAPACITY:4CENSUS: 4DATE:
09/30/2021
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Merari Pina-AguilarTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff does not treat resident with dignity and respect.
Food service is inadequate.
INVESTIGATION FINDINGS:
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At 10:20 am, Licensing Program Analysts Melissa Ruiz and Joscelyn Martinez conducted an unannounced complaint visit to investigate the allegations mentioned above. At approximately 10:35 am, LPA’s requested client files, staff schedules and weekly food menus. LPA’s then began reviewing files, which consisted of but not limited to physician reports, nutrition assessments and individualized program plans (IPPs). LPA’s initiated a physical plant tour at 11:30 am and noted no health and safety concerns. LPA’s met with designee, Merari Pina-Aguilar and explained the purpose of the visit.

Allegation: Staff does not treat resident with dignity and respect.

At 11:40 am, LPA’s interviewed all four (4) clients and they all stated that the staff treats them well and with respect. They have a good relationship with all staff. Interviews with five (5) staff members revealed that none of the staff have witnessed any staff member speak or treat clients in a disrespectful way. Based on the interviews with the clients and staff members, this allegation is deemed unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
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 31-AS-20210923114605
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: DESERT WILLOW HOME
FACILITY NUMBER: 197609956
VISIT DATE: 09/30/2021
NARRATIVE
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Allegation: Food service is inadequate.

Upon arrival, LPA’s observed staff member prepare lunch for clients. LPA’s obtained a copy of the weekly food menu. Today’s menu consisted of a turkey herb sandwich, a salad, and fruit. Lunch time was served at approximately 12:00 pm. Food menu is provided by dietitian from Nutricopia. Based on the client’s interviews, all clients stated they like the food and if they are still hungry, second servings are offered. Four (4) out of five (5) staff members stated they think the food service is adequate and portions are sufficient for the clients. Based on the information obtained from the interviews with clients and staff members, this allegation is deemed unsubstantiated at this time.
Exit interview conducted, report issued. No deficiencies issued.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Joscelyn Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2