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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 10/04/2022
Date Signed: 10/04/2022 02:18:54 PM

Substantiated


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
09/26/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220926152307
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:
10/04/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Shannon Wilkerson/Moore - Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff did not provide medications to a resident while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Executive Director Shannon Wilkerson. Below is a summary of the complaint investigation findings:

Regarding allegation "Staff did not provide medications to a resident while in care": LPA Colvin reviewed medication logs for resident (R1) for the month of September & October 2022. LPA Colvin observed that R1 is prescirbed multiple PRN (as needed) medications, but LPA Colvin did not observe a written statement/certification from R1's physician stating whether or not R1 is able to determine their own need for PRN medications, if they can only relay symptoms, or if they are unable to relay need or symptoms and the doctor must be contacted prior to each dose. LPA Colvin inquired with staff regarding this missing document and was informed that staff simply go by the doctors orders on the prescription, such as if it says "take every 4 hours as needed", staff will administer every 4 hours.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
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 6
Control Number 18-AS-20220926152307
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: 10/04/2022
NARRATIVE
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LPA Colvin observed that despite staff's statement that PRN medication is given as often as stated on the prescription, there were not administrations of the PRN of Quetiapine Fumarate or notes of refusals for the month of September until the 20th, no administration Cetirizine in September 2022 or October 2022, and sporadic administration of PRNs Acetaminophen and Hydrozyzine. Additionally, LPA Colvin observed notes for Buspirone (9/1/22 - 9/21/22, 9/26/22 - 10/4/22) and multiple other medications for 10/1/22 through 10/3/22, which stated "Physically unable to take". LPA Colvin inquired with staff what this note means and staff stated that they did not have the medication for the resident and were waiting for a refill. LPA Colvin reviewed the Centrally Stored Medication Log which showed the medication refilled on 9/26/22, but staff stated that the date listed is not the date received, but the date the order for refill was placed with the pharmacy. LPA Colvin inquired about the missing doses for September, and staff stated that there were issues with getting the medication refilled as R1 had not seen their Primary Care Physician (PCP), and the prior prescriptions were from the hospital. It should be noted that Busporone is prescribed to be taken by the resident twice daily for agitation, and is not a PRN.

Since the facility has not administered all of R1's medications according to physician's orders as noted above, the allegation "Staff did not provide medications to a resident while in care" 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.

Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Executive Director Shannon Wilkerson during the exit interview.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20220926152307
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: 10/04/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/04/2022
Section Cited
CCR
87465(a)(4)
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Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall... provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:
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Licensee agrees to conduct audit of all residents' medication records for September 2022 in order to determine if there are any other residents which were not provided with medications as precribed. Licensee may self-certify to LPA Colvin once complete.
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Based on record review and interview, the Licensee did not comply with the above regulation with one resident. LPA Colvin observed that R1 was out of medication Busiprone for over one month and therefore, it was not administered to R1 by staff. This is an immediate health risk for R1.
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
09/26/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220926152307

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:
10/04/2022
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Shannon Wilkerson/Moore - Executive DirectorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff damaged a resident's personal belongings while in care
Staff stole a resident's personal belongings
Staff inappropriately searched a resident while in care
Resident is being mistreated while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unanounced in order to initiate an investigation of a complaint with the above allegation(s). LPA identified herself and discussed the purpose of the visit and the elements of the allegation(s) with Executive Director Shannon Wilkerson. Below is a summary of the complaint investigation findings:

Regarding allegation “Staff damaged a resident's personal belongings while in care”: LPA Colvin conducted interviews with staff, resident (R1), and others with knowledge of R1's possessions at the facility. LPA Colvin additionally reviewed R1's file regarding property listed in R1's possession at the facility. LPA Colvin was unable to confirm that staff damaged any of R1's possessions due to conflicting statements in interviews, as well as R1's inventory list did not include any items which were claimed to be damaged. Therefore, based on interviews, record review, and lack of other evidence, the allegation "Staff damaged a resident's personal belongings while in care" is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
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 6
Control Number 18-AS-20220926152307
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: 10/04/2022
NARRATIVE
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Regarding allegation "Staff stole a resident's personal belongings": LPA Colvin conducted interviews with staff, resident (R1), and others with knowledge of R1's possessions at the facility. LPA Colvin additionally reviewed R1's file regarding property listed in R1's possession at the facility. LPA Colvin learned through interview with one of R1's Power of Attorney's (POA) that one of the items of concern (tablet) was removed from R1's possession by order of the POA, and the facility has the tablet stored in the med room and available to R1 on request. LPA Colvin inquired about R1's reportedly missing "Alexa" device, but staff did not have knowledge of the device to be missing, though it is noted in R1's property log. While R1's device may have been misplaced by R1 or taken by another (possibly a resident), there is not enough evidence to confirm that R1's "Alexa" was taken specifically by a staff member. Additional items of concern (photos, perfume, makeup) were not listed on R1's property log and staff denied any knowledge of missing items. Therefore, based on record review, interviews, and lack of evidence, the allegation " Staff stole a resident's personal belongings" is UNSUBSTANTIATED.

Regarding allegation "Staff inappropriately searched a resident while in care": LPA Colvin conducted interviews with staff, resident (R1), and others with knowledge of R1's care and history. LPA Colvin attempted to interview the suspected staff (S1) to have inappropriately searched R1, but S1 works the overnight shift at the facility, and did not respond to LPA Colvin's telephone call. Other interviews conducted did not reveal any supporting evidence to the allegation, and staff interviewed denied there being specific objects that R1 is not allowed to have, other than the standard sharp items, and that staff do not search residents. Therefore, due to lack of evidence and conflicting statements, the allegation "Staff inappropriately searched a resident while in care" is UNSUBSTANTIATED.

Regarding allegation "Resident is being mistreated while in care": LPA Colvin interviewed staff, resident (R1), and others with knowledge of R1's care. The majority of interviews conducted with persons who had knowledge regarding the circumstances surrounding the allegation, provided LPA Colvin with a consistent story of events. The allegation is in regards to R1 being "isolated" in another building other than where R1's room is located. Interviews revealed that at some point after R1 was admitted to the facility in May 2022, R1 observed someone type in the security code for the doors to the building where R1 lives, and memorized the code. Staff was made aware of the security breach, and until the code could be reset, R1 was moved during R1's waking hours to the building next door for "Day Programming". LPA Colvin inquired as to what "Day Programming" consisted of, and was informed that it was simply moving R1 to the other building (which had a larger number of staff) during the waking hours for supervision purposes of R1.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20220926152307
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: 10/04/2022
NARRATIVE
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LPA Colvin confirmed with staff that R1 was returned to their building and their room at night so that they would be able to sleep in their bed. LPA Colvin additionally was informed by multiple persons interviewed that R1 has a history of making false allegations, and that R1 will lie about everyone and everything if it suits their needs/agenda. LPA Colvin observed that on R1's Physician's Report dated March 2022 that it was noted that R1 has delusions which R1 believes to be the truth. Therefore, due to lack of evidence suggesting that R1 was mistreated and multiple consistent interviews regarding need for additional security measures for R1, the allegation "Resident is being mistreated while in care" is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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 with Executive Director Shannon Wilkerson and a copy of this report was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6