330910554-5-9-2023-18-AS-JESL-CSD7L5-20230531214459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 330910554
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:24:50 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/20/2022 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220120094745

FACILITY NAME:	PARADISE GUEST RANCH		FACILITY NUMBER:	330910554
ADMINISTRATOR:	VASQUEZ, CONNIE		FACILITY TYPE:	740
ADDRESS:	19150 KRIS ROAD		TELEPHONE:	(760) 329-8905
CITY:	SKY VALLEY	STATE: CA	ZIP CODE:	92241
CAPACITY:	6	CENSUS: 3	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Connie Vasquez, Administrator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff are unwilling to meet resident’s supervision needs.
Staff attempted to have resident hospitalized without cause.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPAs) Jesse Gardner and Janette Romero arrived unannounced to deliver findings to an investigation into the allegations listed above. LPAs met with Administrator Connie Vasquez, and toured the facility.

It was alleged that staff were unwilling to meet the needs of Resident One (R1). Document review revealed that R1 was admitted to the facility on October 21, 2020. R1 lived at the facility approximately 2 years. R1 was diagnosed with Dementia. During this time, R1 declined in behavior and became violent on several occasions to staff and residents. During which, a re-apprasial for R1 was not done to address each new episode, which prevented staff to care for R1, adequately. Thus, this allegation was SUBSTANTIATED.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220120094745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PARADISE GUEST RANCH	FACILITY NUMBER: 330910554
	VISIT DATE: 05/09/2023

NARRATIVE

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It was alleged that staff attempted to have resident hospitalized without cause. Staff interview revealed that R1 had become increasingly violent toward not just residents but staff, in particular, the Administrator. On the latest day of incident, staff notified law enforcement to pick up R1 for a medical evaluation hold at a hospital, and for R1 not to return to the facility. Due to this, the allegation was SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was discussed and provided along with copies of the LIC811, LIC9099D, and Appeal Rights.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20220120094745

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PARADISE GUEST RANCH	FACILITY NUMBER: 330910554
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/09/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/10/2023 Section Cited CCR 87705(c)(5)(a)	1 2 3 4 5 6 7	Care of Persons with Dementia: (c) Licensees who accept and retain residents with dementia shall be responsible...(5) Each resident with dementia shall have an annual medical assessment.. both of which shall..When any medical assessment, appraisal, or observation indicates that the resident’s dementia care needs have changed, corresponding changes shall be made in the care and supervision provided to that resident. This was not being met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to conduct in-service training with staff on the cited regulation and provide proof of such by POC date.
	8 9 10 11 12 13 14	Based on staff interview, and document review, LPA concluded that a re-appraisal was not done for R1 to accurately provide care for R1's needs. This is an immediate health and safety risk to residents in care.	8 9 10 11 12 13 14
Type A 05/10/2023 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	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. This was not being met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to conduct in-service training on the cited regulation and provide proof of such by POC date.
	8 9 10 11 12 13 14	Based on LPA interview with staff, law enforcement was called to remove R1 from the property to not return. This poses an immediate personal rights risk to 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: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Jesse Gardner	TELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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