331880653-10-30-2023-18-AS-RSTS-CX6NE8-20231101102329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880653
Report Date: 10/30/2023
Date Signed: 10/30/2023 07:16:18 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
03/23/2023 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230323131654

FACILITY NAME:	ABSOLUTE DESERT CARE II		FACILITY NUMBER:	331880653
ADMINISTRATOR:	CARLOS, CHANNE		FACILITY TYPE:	740
ADDRESS:	70603 INDEPENDENT CIR		TELEPHONE:	(951) 742-3448
CITY:	RNACHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	0	CENSUS: 0	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	06:27 PM
MET WITH:	Sandie Lapuz, Caregiver		TIME COMPLETED:	07:30 PM

ALLEGATION(S):

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Facility staff failed to provide a full refund.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to Absolute Desert Care I, due to the closure of the above named facility, to deliver the findings of the investigation. The LPA met with Sandie Lapuz, Caregiver, and spoke with Administrator, Channe Carlos, over the phone. Carlos was notified of the purpose for the visit.
The Department received a report alleging the facility failed to provide the responsible party of Resident One (R1) a full refund for the time period of February 2023 after the resident's death. The LPA conducted staff interviews and reviewed records. The Licensee, Nenita Carlos, was interviewed and reported she is responsible for issuing refunds. Nenita reported a refund was issued to R1's responsible party, however, she could not provide the LPA with any information regarding the refund. The LPA reviewed the Admission Agreement for R1; the document revealed the monthly rate charged was $5,500. A carbon copy of the check from February 2023 was received and revealed $5,500 was paid to the facility by the resident's responsible party. According to the facility Administrator, Channe Carlos, R1 passed away on February 06, 2023 and a refund check ($2,017.00) was issued to the responsible party. The LPA received a copy of the check and

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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-20230323131654

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ABSOLUTE DESERT CARE II	FACILITY NUMBER: 331880653
	VISIT DATE: 10/30/2023

NARRATIVE

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verified the information given by the Administrator. Interview revealed R1's belongings were removed from the facility on February 07, 2023. Therefore, twenty-one (21) days remained in the month of February for which the facility did not render any care and supervision. The daily rate for February 2023 was calculated to $196.42. The daily rate for the remaining days in February was calculated to $4,124.82. Therefore an additional refund of $2,107.82 shall be issued.

This allegation is deemed SUBSTANTIATED. A finding that the complaint is substantiated means the allegation is valid because the preponderance of the evidence standard has been met. A citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted; this report was reviewed with Administrator Carlos over the phone and a copy was left at the facility, along with the LIC 811 and instructions on appeal rights.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20230323131654

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ABSOLUTE DESERT CARE II	FACILITY NUMBER: 331880653
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/03/2023 Section Cited CCR 1569.652(c)	1 2 3 4 5 6 7	Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds: (c) A refund of any fees paid in advance covering the time after the resident’s...property has been removed from the facility shall be issued to the individual,	1 2 3 4 5 6 7	The Administrator stated she would review the details of the refund and submit her findings to the LPA. She stated an additional refund would not be issued.
	8 9 10 11 12 13 14	individuals, or entity contractually responsible for the fees...within 15 days after the personal property is removed. This requirement was not met, as evidenced by: Based on records & interviews, the Licensee failed to ensure a refund of fees paid in advance. An additional refund of $2,107.82 shall be issued.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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