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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880722
Report Date: 05/18/2022
Date Signed: 05/18/2022 11:12:18 AM


Document Has Been Signed on 05/18/2022 11:12 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
331880722
ADMINISTRATOR:HUDSON, CHANTELLEFACILITY TYPE:
740
ADDRESS:25818 COLUMBIA STTELEPHONE:
(951) 652-1837
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:58CENSUS: 38DATE:
05/18/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Chantelle Hudson - Executive Director/AdministratorTIME COMPLETED:
11:15 AM
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An Informal Meeting was conducted today via Zoom due to COVID-19 in order to discuss recent concerns and facility's operation. Persons present at today’s meeting were: Licensing Program Manager (LPM) Joel Esquivel, Licensing Program Analyst (LPA) Crystal Colvin, Executive Director/Administrator Chantelle Hudson, Regional Vice President of Operations Lorena Oropeza, Wellness Director Shannon Wilkerson, Regional Wellness Director Dana Belden, and Licensee Representative Tom Stanley. Below are the topics that were addressed during the Informal Meeting tele-visit:
  • Substantiated Complaint #18-AS-20220510084107

  • Staffing


During this meeting it was requested for the Licensee to conduct a review of the facility's residents' needs and subsequent number of staff needed to meet these needs per shift, per building. Report to be provided to LPA Colvin by May 27, 2022. Additionally, it was requested to have the updated Reassessment and Care Plan for one resident (R1) submitted to LPA Colvin by May 27, 2022.

LPM Joel Esquivel and LPA Crystal Colvin offered Licensee Tom Stanley the Technical Support Program (TSP) Assistance. The Licensee expressed interest in the TSP Program, but declined a referral at this time due to the facility's Executive Director/Administrator leaving on June 6, 2022.

An exit interview was conducted and a copy of this report was provided via email to Executive Director/Administrator Chantelle Hudson for signature.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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