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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:14:56 PM

Substantiated


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
01/31/2024 and conducted by Evaluator Stephanie Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240131082100
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: 33DATE:
02/08/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Shannon Moore Wilkerson, AdministratorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Unqualified staff giving residents injections
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Shannon Wilkerson, Administrator, and informed her of the purpose for the visit.

A report was received alleging residents in care are receiving injections from unqualified staff. According to Administrator Wilkerson, there has only been two residents in care, in the last four (4) months, who have required injections. She reported it is only the staff who have a LVN (Licensed Vocational Nurse) license, or herself, who will administer injections to residents in care. Staff interviews and records refuted the Administrator’s statement. Two out of four staff interviews revealed medication technicians, who are not considered appropriately skilled professionals, have been observed to administer injections to residents in care. In addition, Resident One's (R1's) and Resident Two's (R2's) Medication Administration Records, revealed Staff One (S1) and Staff Two (S2) administered injections to R1 in November and December 2023 and to R2 in January and February 2023. According to Administrator Wilkerson, she was present to provide
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
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 4
Control Number 18-AS-20240131082100
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: 02/08/2024
NARRATIVE
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residents with their injections and could not initial the MAR due to the functions of the electronic MAR. No notes were found on the MAR to indicate the Administrator, rather than S1 or S2, had administered the injections. Therefore, based on interviews and records review, this allegation is deemed SUBSTANTIATED at this time. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted; this report was reviewed with Administrator Wilkerson and a copy was provided, along with LIC 811 and instructions on appeal rights.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20240131082100
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/09/2024
Section Cited
CCR
87629(b)(1)
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INJECTIONS: (b)...the licensees who admit or retain residents who require injections shall be responsible for the following: (1) Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement was not met, as evidenced by: Based on interviews &
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Administrator Wilkerson stated a physical copy of the Medication Administration Record (MAR) will be utilized when she or another individual is administering injections.
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records review, the Licensee didn't ensure staff who were appropriately skilled professionals administered injections to residents who required assistance. Staff interviews & MARs revealed staff who are not appro. skilled professionals were administering injections.
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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.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 02/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4