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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 10/23/2020
Date Signed: 10/29/2020 01:52:12 PM



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
09/30/2020 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200930165323
FACILITY NAME:DESERT HILLS MEMORY CARE CENTERFACILITY NUMBER:
331880722
ADMINISTRATOR:HUDSON, CHANTELLEFACILITY TYPE:
740
ADDRESS:25818 COLUMBIA STTELEPHONE:
(951) 652-1837
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:58CENSUS: 43DATE:
10/23/2020
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Chantelle HudsonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal items
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility to deliver findings for the above allegation via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Administrator, Chantelle Hudson.

LPA interviewed Staff #1 (S1), Staff #2 (S2) and Staff #3 (S3) who all denied that staff are not safeguarding Resident #1's (R1's) personal items. According to S1, R1 came to the facility with minimal clothing, so facility staff are frequently washing R1's clothing items. S1 stated that after R1's clothes are washed, staff immediately put the items in R1's closet, which is locked. LPA attempted to interview R1; however, due to R1's condition, LPA concluded the interview.

Based on evidence obtained during today’s visit, LPA has determined that the above allegation is UNSUBSTANTIATED; meaning that although the allegation may have happened or is valid,
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2020
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-20200930165323
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: DESERT HILLS MEMORY CARE CENTER
FACILITY NUMBER: 331880722
VISIT DATE: 10/23/2020
NARRATIVE
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there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy was provided to the administrator via email.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 10/27/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2