331880511-11-5-2021-18-AS-NBRN-CE9UBR-20220509152646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880511
Report Date: 11/05/2021
Date Signed: 11/05/2021 12:24:18 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, 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
05/07/2020 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200507101825

FACILITY NAME:	PALMS AT LA QUINTA, THE		FACILITY NUMBER:	331880511
ADMINISTRATOR:	PATRICK MCADOO-MORTON		FACILITY TYPE:	740
ADDRESS:	45160 SEELY DRIVE		TELEPHONE:	(760) 345-5353
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	120	CENSUS: 103	DATE:	11/05/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Ruth Fromme		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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1)Facility staff failed to seek medical attention for resident
2)Facility denied Physical Therapist in to see patient due to COVID-19
3)Resident's medication is not being administered per doctor's order
4)Unqualified staff providing care to residents

INVESTIGATION FINDINGS:

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On 11/5/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of delivering the findings to the above allegations. The LPA met with Ruth Fromme, explained the nature of the visit and was granted entry.

The investigation which consisted of interviews and file review revealed the following:
1)Facility staff failed to seek medical attention for Resident 1 (R1):
R1 sustained a fall at Manor Care on 4/3/20. R1 was discharged to The Palms at La Quinta on 4/4/20. R1 complained of pain on 4/5/20 and was sent to the hospital on 4/10/20. In the interim, R1 was provided with pain medication. File review confirmed this information. R1 could not be interviewed because they no longer reside at the facility.
***continued on LIC 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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-20200507101825

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: PALMS AT LA QUINTA, THE	FACILITY NUMBER: 331880511
	VISIT DATE: 11/05/2021

NARRATIVE

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***Continued from LIC 9099***

2)Facility denied Physical Therapist to visit R1 due to COVID-19:
An interview with the ED confirmed that visitation was restricted due to the COVID-19 pandemic. The facility had positive COVID-19 cases within the facility. The facility was following the Center for Disease Control (CDC) and Community Care Licensing (CCL) guidelines.

3)Resident's medication is not being administered per physician's orders:
R1's Medication Administrator Record (MAR) indicates R1 was receiving medication per the physician's orders.

4)Unqualified staff providing are care to residents:
An interview with the ED revealed that all staff received training on donning and doffing personal protective equipment (PPE). Documentation indicates mandatory training was held on 4/10/21, which included how to properly use PPE.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report and LIC 811 were provided to Ruth Fromme.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

LIC9099 (FAS) - (06/04)

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