331800160-8-16-2021-18-AS-EMAN-C6ATXG-20210827150705

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800160
Report Date: 08/16/2021
Date Signed: 08/16/2021 12:01:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/20/2020 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200220165119

FACILITY NAME:	HIGHGATE SENIOR LIVING-TEMECULA		FACILITY NUMBER:	331800160
ADMINISTRATOR:	WILLIAMS, KATHLEEN		FACILITY TYPE:	740
ADDRESS:	42301 MORAGA ROAD		TELEPHONE:	(951) 308-1885
CITY:	TEMECULA	STATE: CA	ZIP CODE:	92591
CAPACITY:	99	CENSUS: 98	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	11:25 AM
MET WITH:	Stephanie Love, Health Care Director		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility does not have a designated person acting in Administrators absence

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegation. The LPA was greeted by receptionist Louisa and later met with Health Care Director, Stephanie Love.

Pertaining to the allegation, "Facility does not have a designated person acting in Administrators absence," it was alleged director, Kathleen Williams, had been absent for one (1) week and the facility was without an administrator and no one acting as the administrator. LPA, Naisha Kendrix, initiated the investigation on February 24, 2020; she conducted staff interviews, reviewed records, and took copies of pertinent documentation. Administrator Williams was interviewed; she reported she had an unexpected, emergency, absence from the facility from February 16, 2020 through February 20, 2020, and ensured coverage was available during this period. Interviews reported Staff One (S1), Two (S2), Three (S3), and Four (S4) were present and available during Williams' absence. Each of these staff members did not have an Administrator's

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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-20200220165119

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: HIGHGATE SENIOR LIVING-TEMECULA	FACILITY NUMBER: 331800160
	VISIT DATE: 08/16/2021

NARRATIVE

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certification at the time. Interviews reported operation at the facility proceeded, as usual, with no reports of concerns to the health, safety, or personal rights of the residents in care. Therefore, due to interviews reporting William's absence being unexpected, this allegation is deemed UNSUBSTANTIATED at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No citations have been issued at this time.

This report was reviewed with Love and a copy was provided.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC9099 (FAS) - (06/04)

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