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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880511
Report Date: 07/18/2022
Date Signed: 07/18/2022 04:08:01 PM


Document Has Been Signed on 07/18/2022 04:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:PALMS AT LA QUINTA, THEFACILITY NUMBER:
331880511
ADMINISTRATOR:PATRICK MCADOO-MORTONFACILITY TYPE:
740
ADDRESS:45160 SEELY DRIVETELEPHONE:
(760) 345-5353
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:120CENSUS: 81DATE:
07/18/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Jennifer Cunningham, Resident Care DirectorTIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to the facility to follow-up on the death of two residents (R1, R2). LPA made contact with Resident Care Director (RCD) Jennifer Cunningham and advised the reason for the visit. RCD accompanied LPA on a tour of the facility.

Community Care Licensing Division (CCLD) received a SOC341 to report the death of two residents. Facility also reported the deaths via the duty line with follow up from LPA. The following is a brief description of the visit:

LPA interviewed Ms. Cunningham regarding the circumstances of the residents death. LPA collected pertinent resident file information, relevant responsible party contact information, as well as staff and resident roster information.

Ms. Cunningham was advised that additional information including, interviews, calls, and record review may be needed to complete CCLD's investigation at a later date.

An exit interview was conducted with Ms. Cunningham, and a copy of this report was provided along with a copy of the LIC811.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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