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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 09/29/2021
Date Signed: 09/29/2021 11:19:20 AM



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
07/27/2020 and conducted by Evaluator Stephanie Williams
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200727104628
FACILITY NAME:DESERT HILLS MEMORY CARE CENTERFACILITY NUMBER:
331880722
ADMINISTRATOR:HUDSON, CHANTELLEFACILITY TYPE:
740
ADDRESS:25818 COLUMBIA STTELEPHONE:
(425) 408-9141
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:58CENSUS: 36DATE:
09/29/2021
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Chantelle HudsonTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Facility neglect resulting in resident sustaining a fracture
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Stephanie Williams conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA Williams identified herself and met with Administrator, Chantelle Hudson. The investigation consisted of records review and interviews with staff and residents.

Department staff collected Resident #1’s (R1’s) medical records which indicated that on July 24th 2020, R1 was transported via ambulance to a local hospital for left hip pain. The primary diagnosis for admission was subcapital/femoral neck fracture of the left hip with shortening and Osteopenia with Degenerative Joint Disease. Department staff interviewed R1’s physician, who stated that due to R1’s age and history of Osteopenia and Degenerative Joint Disease, the fracture may be caused by a fall or a twisting/rotational movement of the leg; such as, standing/sitting incorrectly, using the restroom and/or showering. R1’s physician was unable to determine the age of the fracture from the x-rays taken. Department staff interviewed Staff #1 (S1) who were unable to explain how R1 sustained the fracture; however, S1 did state that R1
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: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
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 2
Control Number 18-AS-20200727104628
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: 09/29/2021
NARRATIVE
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 R1 sustained a fall one week prior. According to S1, the facility’s nurse assessed R1 for injuries and pain; however, there was no pain or injuries documented. There is insufficient evidence to prove the allegation of neglect/lack of supervision had occurred; therefore, the allegation is unsubstantiated.

Based on evidence obtained during the investigation, LPA has determined that the above allegation is 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 was discussed and a copy was provided to the Administrator.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2