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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880652
Report Date: 08/18/2021
Date Signed: 08/18/2021 10:44:57 AM

Substantiated


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
09/26/2019 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20190926112814
FACILITY NAME:ABSOLUTE DESERT CARE IFACILITY NUMBER:
331880652
ADMINISTRATOR:CARLOS, CHANNEFACILITY TYPE:
740
ADDRESS:73137 SOMERA RDTELEPHONE:
(951) 742-3448
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 5DATE:
08/18/2021
UNANNOUNCEDTIME BEGAN:
09:52 AM
MET WITH:Viridiana CisnerosTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Facility staff failed to cross report as required by law.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jennifer Semin made an unannounced visit to the facility to deliver the final complaint investigation report. LPA met with Viridiana Cisneros and spoke with Licensee Channe Carlos via telephone.

The investigation consisted of interviews with staff, resident and relevant party. Interviews revealed that the licensee admitted to being made aware of an incident that may have occurred and was reported by the Resident 1's (R1) responsible party and did not submit reports to required agencies, including the local ombudsman, the corresponding licensing agency, and the local law enforcement agency.
Based on interviews the above allegations are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met. Citation will be issued, see LIC9099D for details.

An exit interview was conducted where this report was discussed with Channe Carlos via telephone and provided to Viridiana Cisneros .

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
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 2
Control Number 18-AS-20190926112814
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: ABSOLUTE DESERT CARE I
FACILITY NUMBER: 331880652
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/18/2021
Section Cited
CCR
87211(c)
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REPORTING REQIREMENTS: Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours. This requirement was not met as evidence by:
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Licernsee shall read regulation 87608 in it's entirety,train staff on this regulation and submit a statement of understanding and training log to CCL by the POC due date of 8/19/2021.
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the licensee admitted to being made aware of an incident that may have occurred and was reported by the Resident 1's (R1) responsible party and did not submit reports to required agencies. This poses a health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2