331880511-6-29-2021-18-AS-NBRN-C5MUHG-20210806153555

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880511
Report Date: 06/27/2021
Date Signed: 06/29/2021 02:20:42 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
01/04/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210104095211

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: 53	DATE:	06/27/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Chris Taber, Director of Health Services		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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1)Facility is operating without an administrator
2)Facility staff are not ensuring residents are eating their meals
3)Facility did not seek medical attention for a resident's injury
4)Facility staff did not report details of a resident's injury to authorized representative timely
5)Staff did not safeguard a resident's property
6)Facility did not allow a resident to leave the facility
7)Resident was over medicated

INVESTIGATION FINDINGS:

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On 6/27/21, Licensing program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of delivering the finding to the above allegation, LPA met with xxx, explained the nature of the visit and was granted entry.

The investigation, which consisted of interviews and document review, revealed the following:

1)Facility is operating without an administrator:
Patrick McAdoo-Morton left his position as Executive Director on 10/27/20. Roby Hosier, Operations Specialist/Executive Director, was appointed the position on 11/2/20. Ruth Fromme also provided support as acting Administrator during McAdoo-Morton’s departure. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

***Page 1 of 3***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2021

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 3

Control Number 18-AS-20210104095211

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: 06/27/2021

NARRATIVE

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***Continued from 9099 Page 1***

2) Facility staff are not ensuring residents are eating their meals
This allegation is in reference to Resident 1 (R1). Documentation supports that facility staff monitored R1's intake and took the necessary precautions to help improve R1's food intake. R1 was provided Ensure drinks 3 times per day, per the physician's orders. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

3) Facility did not seek medical attention for a resident's injury
R1 sustained a fall on 11/13/20 and R1 was assessed by a licensed nurse at the facility. It was determined that R1 did not require an Emergency Room (ER) visit. R1's physician was notified as well as Community Care Licensing (CCL). On 11/20/20, the family of R1 requested that R1 be sent to the ER. The facility complied, R1 was assessed in the ER and was returned back to the facility. No major injuries were noted. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

4) Facility staff did not report details of a resident's injury to authorized representative timely
R1 sustained a fall on 11/13/20 at 0745 and R1's responsible party (RP) was contacted by a licensed nurse at 0900 on the same day. Community Care Licensing (CCL) was notified of the incident as required. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

5) Staff did not safeguard a resident's property
R1 is a memory care resident and it is possible that R1 misplaced some of her belongings. It was not determined that R1’s personal items were stolen by staff. Documentation indicates items recovered for R1. Due to the COVID-19 epidemic, the facility did not allow visitors into the building. Upon discharge of R1, the facility staff notified the RP that R1's belongings would be removed from R1’s apartment and placed at the entrance of the Memory Care. The RP was reminded on the day of pick-up, which was 1/1/21. It was reported that the items were supervised. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

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SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20210104095211

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: 06/27/2021

NARRATIVE

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***Continued from 9099 Page 2***

6) Facility did not allow a resident to leave the facility
R1's RP contacted the facility on 12/30/20 and notified staff that R1 would be removed from the facility on 1/1/21. The RP was reminded that this violated the 30-day notification, therefore the RP was responsible for January full month's payment. Facility staff contacted the RP on 1/1/21 and reminded them that after they picked up R1's belongings, they needed to stop by the front office to deliver the January 2021 payment. The Executive Director denied not allowing the R1 to leave the facility. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

7) Resident was over medicated
Document review revealed that R1 was provided the correct medication dosages for the months of November 2020 and December 2020. CCL did not receive special incident reports indicating that R1 was over medicated. The facility denied over medicating R1. The LPA was unable to corroborate the allegation; therefore, this allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report was discussed with and provided to Chris Taber.

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SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Shaunte Henry
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2021

LIC9099 (FAS) - (06/04)

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