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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880652
Report Date: 08/18/2021
Date Signed: 08/18/2021 10:46:51 AM

Document Has Been Signed on 08/18/2021 10:46 AM - 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:ABSOLUTE DESERT CARE IFACILITY NUMBER:
331880652
ADMINISTRATOR:CARLOS, CHANNEFACILITY TYPE:
740
ADDRESS:73137 SOMERA RDTELEPHONE:
(760) 636-1910
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY: 6CENSUS: 5DATE:
08/18/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Viridiana CisnerosTIME COMPLETED:
11:02 AM
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Licensing Program Analyst (LPA) Jennifer Semin conducted this case management visit in conjunction with Complaint number 18-AS-201909261128145. . LPA met with Viridiana Cisneros and spoke with Licensee Channe Carlos via telephone.

During the course of the complaint investigation on 10/3/2019, LPA was informed by Staff 2 (S2) that in order to prevent R1 from getting out of bed, Staff 1 (S1) would elevate the bed to prevent R1 from getting out of bed on their own. Staff 2 (S2) stated that S1 had demonstrated to S2 how to elevate the bed so R1 would not get out. Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict movement including, preventing a resident from falling out of bed. This requirement was not met as evidence by staff elevated bed to prevent R1 from getting out of bed. This poses a health and safety risk to residents in care. A deficiency will be cited.

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

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/18/2021 10:46 AM - It Cannot Be Edited


Created By: Jennifer Semin On 04/16/2021 at 12:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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 A
08/19/2021
Section Cited
CCR
87608(a)(1)

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POSTURAL SUPPORTS:...Postural supports may be used under the following conditions. Postural supports shall be limited to appliances or devices such as braces, spring release trays, or soft ties, used to achieve proper body position and balance, to improve a resident's mobility and independent functioning, or to position rather than restrict
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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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movement including, but not limited to, preventing a resident from falling out of bed, a chair, etc.
This requlation was not met as evidence by: staff elevated bed to prevent Resident 1 (R1) from getting out of bed. 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.
SUPERVISOR'S 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


LIC809 (FAS) - (06/04)
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