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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880653
Report Date: 02/10/2023
Date Signed: 02/10/2023 09:39:21 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200427155556
FACILITY NAME:ABSOLUTE DESERT CARE IIFACILITY NUMBER:
331880653
ADMINISTRATOR:CARLOS, CHANNEFACILITY TYPE:
740
ADDRESS:70603 INDEPENDENT CIRTELEPHONE:
(951) 742-3448
CITY:RNACHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:6CENSUS: DATE:
02/10/2023
ANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Channe Carlos, Administrator TIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff overmedicated the resident.
Staff continued to provide discontinued medication to the resident.
The resident had multiple pressure injuries.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rayshaun Nickolas met with Administrator Channe Carlos in the Riverside/San Bernardino Regional Office to deliver findings on the above allegations. The investigation consisted of interviews and reviewed facility file documents pertinent to the investigation.

Allegation #1 “Staff over medicated the resident”. The allegation alleges that client #1 (C1) was overmedicated. LPA interview with the RP revealed that the RP has never visited the facility. LPA interview with the RP also revealed that the RP was not informed by C1 or facility staff that C1 was overmedicated. LPA review of C1’s Medication Administration Record (MAR) indicated that C1 was provided medication as ordered by their physician. Investigation into this incident revealed insufficient evidence to corroborate the alleged allegation.
Allegation #2 “Staff continued to provide discontinued medication to the resident.” The allegation alleges that C1 was given discontinued medication. LPA interview with the RP revealed that the RP has never visited the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
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 4
Control Number 18-AS-20200427155556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: ABSOLUTE DESERT CARE II
FACILITY NUMBER: 331880653
VISIT DATE: 02/10/2023
NARRATIVE
1
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4
5
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7
8
9
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LPA interview with the RP also revealed that the RP was not informed by C1 or facility staff that the staff continued to provide C1 with discontinued medication. LPA compared C1’s MARs with their “Current Treatment/Medication List/DME, " which revealed that facility staff did not provide C1 with discontinued medication. Investigation into this incident revealed insufficient evidence to corroborate the alleged allegation.

Allegation # 3, “The resident had multiple pressure injuries”. The allegation alleges that C1 had multiple pressure injuries. LPA interview with staff # 1 (S1) revealed that C1 had a wound and did acknowledge informing the RP of it. However, the facility constantly communicated with the hospice nurse and requested wound care. LPA facility file review revealed that the facility communicated continuously with the hospice nurse and asked for wound care on several occasions. Investigation into this incident revealed insufficient evidence to corroborate the alleged allegation.

Based on evidence obtained during the investigation, LPA has determined that the above allegations are Unsubstantiated; meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Carlos and a copy of this report was provided.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2020 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200427155556

FACILITY NAME:ABSOLUTE DESERT CARE IIFACILITY NUMBER:
331880653
ADMINISTRATOR:CARLOS, CHANNEFACILITY TYPE:
740
ADDRESS:70603 INDEPENDENT CIRTELEPHONE:
(951) 742-3448
CITY:RNACHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:6CENSUS: DATE:
02/10/2023
ANNOUNCEDTIME BEGAN:
09:31 AM
MET WITH:Channe Carlos, AdministratorTIME COMPLETED:
09:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide proper incontinence care.
Facility failed to ensure proper hospice services were provided.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rayshaun Nickolas met with Administrator Channe Carlos in the Riverside/San Bernardino Regional Office to deliver findings on the above allegations. The investigation consisted of interviews and reviewed facility file documents pertinent to the investigation.

Allegation #4, “Facility failed to provide proper incontinence care”. LPA interview with the reporting party (RP) revealed that the RP never visited the facility while client # 1 (C1) was in care. LPA interview with the RP also revealed that the RP was not informed by C1 or facility staff that the facility failed to provide proper incontinence care. The LPA facility file review revealed that the staff charted C1’s restroom visits and diaper changes. The finding is unfounded

Allegation #5, “Facility failed to ensure proper hospice services were provided”. LPA facility file review revealed that C1 received in-person care with a hospice nurse and FaceTime visits with a hospice nurse while residing there. The finding is unfounded.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20200427155556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: ABSOLUTE DESERT CARE II
FACILITY NUMBER: 331880653
VISIT DATE: 02/10/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A finding of unfounded means that the allegation is false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Carlos and a copy of this report was provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4