331880722-5-19-2025-18-AS-APAO-DGWREB-20250522125715

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 05/19/2025
Date Signed: 05/19/2025 01:44:26 PM

Unsubstantiated

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
01/22/2024 and conducted by Evaluator Janira Arreola

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240122095107

FACILITY NAME:	DESERT HILLS MEMORY CARE CENTER		FACILITY NUMBER:	331880722
ADMINISTRATOR:	HUDSON, CHANTELLE		FACILITY TYPE:	740
ADDRESS:	25818 COLUMBIA ST		TELEPHONE:	(951) 652-1837
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	58	CENSUS: 30	DATE:	05/19/2025
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Executive Director, Shannon Moore		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Staff do not ensure that resident's dental needs are being met.
Resident's room is in disrepair.
Staff are preventing resident from leaving the facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Executive Director, Shannon Moore, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented conducted a walk through, and conducted records review.

It was alleged that “Staff are preventing resident from leaving the facility.” It was alleged that Resident #1 (R1) had legally revoked their Power of Attorney (POA) and became self- responsible on 01/16/2024. It was alleged that R1 was not allowed to leave the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

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 3

Control Number 18-AS-20240122095107

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: DESERT HILLS MEMORY CARE CENTER	FACILITY NUMBER: 331880722
	VISIT DATE: 05/19/2025

NARRATIVE

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LPA attempted to conduct interview with R1, however they were unavailable. LPA conducted interviews with residents (2) residents who resided at the facility when the complaint was received. (1) of (2) residents revealed they recalled R1 but did not know if staff was preventing R1 from leaving the facility.

Department staff conducted (2) administrative staff interviews which revealed R1 provided a copy of their new POA documents and moved out the same day 01/29/2024.

R1’s file revealed the facility received a faxed letter from R1’s attorney dated 01/16/2024. Facility sign out sheets and SOC341 for R1 revealed that on 01/29/2024 R1’s attorney came to visit R1, and R1 moved out of the facility the same day. Therefore based on interviews and records review the allegation that R1 was not allowed to leave the facility is unsubstantiated.

It was alleged “Staff do not ensure that resident's dental needs are being met.” It was alleged that Resident #1 (R1) was denied medical care to see a dentist for a broken tooth since May of 2023 by the facility. The Department received a photo showing a chipped tooth which allegedly belonged to R1. LPA attempted to conduct interview with R1, however they were unavailable.

LPA conducted interviews with (2) residents who resided at the facility when the complaint was received. (1) of (2) resident’s recalled R1 and revealed they did not recall R1 mentioning they were being denied medical care. (2) of (2) residents revealed staff assists them in making doctor’s appointments when needed.

Department staff conducted (4) staff interviews. (3) of (4) staff revealed no staff refused to make medical or dental appointments for R1. (3) of (4) staff revealed R1 would refuse to attend doctor’s appointments and refused to be taken out for medical treatment. R1’s file revealed R1 attended a dental appointment on 10/02/2023 for a broken tooth which revealed R1 refused care.

Therefore based on interviews and records review the allegation that R1 was denied dental care while at the facility is unsubstantiated.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20240122095107

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: DESERT HILLS MEMORY CARE CENTER	FACILITY NUMBER: 331880722
	VISIT DATE: 05/19/2025

NARRATIVE

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It was alleged “Resident's room is in disrepair.” It was alleged that R1’s room had a hole in the ceiling for (1) month in January 2024 and was not repaired. It was alleged the hole was observed on 01/05/2024 and again on 01/17/2024, with a plastic sheet over it. The Department received a photo of a hole in dry wall which was covered by a taped plastic sheet. It was alleged this was located in R1's room ceiling. LPA attempted to conduct interview with R1, however they were unavailable.

LPA conducted interviews with (2) residents who resided at the facility when the complaint was received. (2) of (2) residents confirmed the facility ceiling had a leak which was repaired promptly. (1) of (2) residents revealed they would visit R1 in their room and revealed R1’s ceiling leak was repaired promptly.

Department staff conducted (6) staff interviews. (5) of (6) staff revealed R1’s room had a leak and R1 and their roommate were provided an alternate room, but R1 refused to move out of the room. (4) of (6) staff revealed R1’s leak was repaired promptly, however R1 refused for staff repair the hole in the ceiling.

Facility records revealed on 11/16/2023 a roofing company was hired for repair. (1) administrative staff revealed repairs continued until January of 2024, and R1's ceiling hole was able to be repaired when R1 moved out.

Therefore, based on interviews and records review the allegation that R1’s room was in disrepair is unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:	DATE: 05/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025

LIC9099 (FAS) - (06/04)

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