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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 04/29/2021
Date Signed: 04/29/2021 01:24:27 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
04/20/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210420120745
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: 36DATE:
04/29/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Chantelle HudsonTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Resident was denied visitors
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to initiate a complaint investigation into the above allegation. LPA contacted the Administrator, Chantelle Hudson, via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Hudson. The investigation consisted of interviews with staff, residents, and witnesses, and records review.

In regards to allegation #1, LPA interviewed Staff #1 (S1) and Staff #2 (S2) who both stated that Witness #1 (W1) was denied entry into the facility because W1 was an ex-employee of the facility who did not leave on good terms. S1 and S2 stated that the facility's attorney was notified that W1 was present at the facility and the attorney advised staff to not give W1 access into the facility. S1 stated that Witness #2 (W2) was able to come into the facility; however, W2 did not have a face shield. S1 stated that W2 was invited to come back with a face shield but W2 never returned to the facility. W1 and W2 came to the facility for the purpose of assessing Resident #1 (R1). Based on staff interviews which confirm R1 was denied visitors, the preponderance of evidence standard has been met; therefore, the allegation is substantiated.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
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 5
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
04/20/2021 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210420120745

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: 36DATE:
04/29/2021
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Chantelle HudsonTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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2
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9
Resident does not have access to personal belonging
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to initiate a complaint investigation into the above allegation. LPA contacted the Administrator, Chantelle Hudson, via telephone due to the COVID-19 pandemic. LPA identified herself and discussed the purpose of the call with Hudson. The investigation consisted of interviews with staff, residents, and witnesses, and records review.

In regards to allegation #2, LPA interviewed S1 who stated that R1's laptop is locked in S1's office drawer for additional safekeeping. S1 stated that R1's requests to use the laptop is accommodated; however, S1 stated that R1 rarely requests to use the laptop. S1 stated that there have been multiple occasions where S1 has worked directly with R1 to use the laptop. LPA was unable to interview R1 due to health diagnosis. Due to the lack of evidence to corroborate that the resident does not have access to personal belonging, the allegation is unsubstantiated.

Based on evidence obtained during today’s tele-visit, LPA has determined that the above allegation is
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: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20210420120745
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: 04/29/2021
NARRATIVE
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UNSUBSTANTIATED; meaning that although the allegation 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 where this report (LIC 9099, LIC 9099C, & LIC 9099D) was discussed with Hudson. A copy of this report and appeal rights were also provided to Hudson via email.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 18-AS-20210420120745
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: 04/29/2021
NARRATIVE
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Based on the evidence gathered during the investigation, the allegation is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where this report (LIC 9099, LIC 9099C, & LIC 9099D) was discussed with Hudson. A copy of this report and appeal rights were also provided to Hudson via email.

SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210420120745
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/30/2021
Section Cited
CCR
87468/1(a)(11)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (11) To have their visitors, including ombudspersons and advocacy representatives, permitted to visit privately during reasonable hours...This requirement was not met as evidenced by:
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The Licensee shall conduct training with staff members regarding residents personal right's, including the facility visitor policy, and send proof to the Department by POC date of 4/30/21.
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Based on interviews with staff members and witnesses, it was confirmed that W1, an advocacy representative, was not permitted to visit R1 during reasonable hours. This is an immediate health and safety risk.
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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: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 5