331880722-5-12-2022-18-AS-JESL-CKMTF7-20221028144105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880722
Report Date: 05/12/2022
Date Signed: 05/12/2022 02:08:54 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
05/10/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220510084107

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: 38	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Shannon Wilkerson - Wellness Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff not ensuring a safe and healthful environment

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 Wellness Director Shannon Wilkerson. Below is a summary of the complaint investigation findings:

Regarding allegation "Staff not ensuring a safe and healthful environment": LPA Colvin conducted interviews with staff and residents, as well as reviewed the file for the resident (R1) who is identified in the complaint. LPA Colvin confirmed through interviews that R1 has the following observed behaviors: wandering into other resident rooms, wandering in a state of undress, and sexual behavior with female resident(s). LPA Colvin observed that in R1's Physican's Report (dated 8/19/21), R1 was not noted to have any inappropriate behaviors, but it documented to be prone to wandering and sundowning, though there is no further explination of the specifics behind R1's sundowning. Additionally, LPA Colvin obserevd a typed note in R1's file dated 12/13/21 and signed by the Administrator, which details R1 as having "hypersexual behavior".

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220510084107

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: 05/12/2022

NARRATIVE

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While the note states that R1's wife and doctor was notified, there was no reassessment of R1 to document these new behaviors. LPA Colvin observed a single Resident Assessment for R1 (dated 11/17/21), in which the only items noted under Behavior/Cognitive Support are: 1. "At risk if allowed access to personal grooming and hygiene items" 2. "Not able to exit building without verbal cue", 3. "Consistently disoriented to time and person", and 4. "Current social behaviors: Very Social". Additionally, LPA Colvin requested to see the staff notes for the last 30 days for R1. Upon review of these notes, LPA Colvin observed that the notes are medical/physical health related, and do not document R1's behaviors and staff's response to them. There is evidence of R1 having displayed behaviors (sexual behaviors & wandering in state of undress & into other resident rooms) other than those indicated on R1's last assessment, and these behaviors could cause harm to other residents. Since the facility has not completed a new reassessment of R1 and clearly identified how they are going to address these behaviors, and furthermore, have no documentation to show that these behaviors are being addressed, the complaint "Staff not ensuring a safe and healthful environment" 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 Wellness Director Shannon Wilkerson during the exit interview.

*Note: When LPA Colvin was going over the findings of the complaint with Wellness Director Shannon Wilkerson, Shannon informed LPA Colvin that another Service Plan was done for R1 which addressed these behaviors, but that it was on the computer. Shannon returned after a period of time with the same Service Plan from R1's move into the facility, but this plan had an attached "Resident Care Associate Guide" dated 11/15/21. This page additionally had a hand-written note at the bottom, dated 12/10/21, which included directions for staff to redirect R1 for sexual behaviors and wandering. LPA Colvin observed that this note is not signed, and since it is hand-written, LPA Colvin cannot verify that it was done on that date and not today. Additionally, R1 did not have a reassessment to accompany this updated Service Plan. Shannon additionally provided LPA Colvin with proof of staff training on 12/9/21 & 12/15/21 for residents with sexual behaviors. This training did not include any mention of documenting residents' behaviors or staff's intervention.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220510084107

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: 05/12/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 05/13/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities: a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met by:	1 2 3 4 5 6 7	Licensee agrees to reassess R1 and document changes in R1 not reflected in prior assessment. Licensee to additionally create a new care plan to reflect R1's needs and staff's role in meeting these needs. LPA Colvin additionally encourages the facility to start documenting staff's observations of these
	8 9 10 11 12 13 14	Based on interviews and record review, the Licensee did not comply with the above regulation with one resident. R1 has new behaviors since admission. Facility staff have not reassessed R1 or documented behaviors and staff inteventions. This is an immedaite safety risk to residents in care.	8 9 10 11 12 13 14	noted behaviors, and staff's response to these behaviors in order to show that residents' safety and personal rights are being upheld. Licensee to provide LPA Colvin with udpated reassessment and care plan by plan of correction date of 5/13/22.
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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 Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022

LIC9099 (FAS) - (06/04)

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