331880734-5-9-2023-18-AS-MVAO-CWZUYA-20231027155937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880734
Report Date: 05/09/2023
Date Signed: 05/09/2023 03:39:11 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
05/05/2023 and conducted by Evaluator Stephanie Torres

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230505131306

FACILITY NAME:	RANCHO MIRAGE TERRACE		FACILITY NUMBER:	331880734
ADMINISTRATOR:	MONIQUE MOREIRA		FACILITY TYPE:	740
ADDRESS:	34560 BOB HOPE DRIVE		TELEPHONE:	(760) 770-7737
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	142	CENSUS: 114	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Monique Moreira, Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Lack of supervision resulted in resident sustaining injuries from falls.
Facility failed to provide resident with planned activities.
Staff did not ensure that resident's care needs were met while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to start the investigation into the above allegations. The LPA met with Executive Director (ED), Monique Moreira, and informed her of the purpose of her visit.

The investigation included staff/resident interviews, records review and records collection.

An allegation was reported to the Department alleging lack of supervision of Resident One (R1) who sustained injuries as a result of several falls. The resident's Physician's Report for Residential Care Facilities for the Elderly (RCFE) was reviewed; it revealed R1 has no motor impairment/paralysis and has a designated nonambulatory status. The Resident Functional Needs Service Plan revealed R1 requires intervention three times per day to decrease identified fall risk. Staff interviews revealed R1 did sustain two falls while in care. According to interviews and a Resident Note, no injuries were observed on R1 when assessed after two falls occurred on April 04, 2023. R1 declined to be interviewed. Therefore, due to insufficient information, this

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

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-20230505131306

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: RANCHO MIRAGE TERRACE	FACILITY NUMBER: 331880734
	VISIT DATE: 05/09/2023

NARRATIVE

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allegation is deemed UNSUBSTANTIATED at this time.

It was also alleged facility staff failed to provide R1 with planned activities. Staff interviews revealed R1 was encouraged to come out of their bedroom to participate in activities; however, the resident refused to leave their room. An interview was attempted with R1, however, they declined to answer any questions. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

Lastly, it was alleged facility staff did not ensure R1's care needs were met while in care. It was reported R1 was left in the same clothing worn the day prior, and not assisted to change. Staff interviews revealed R1 was assisted to change partially, however, declined further assistance from staff on or around April 04, 2023. R1 declined to be interviewed. Therefore, due to insufficient information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

This report was reviewed with Moreira and a copy was provided.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Stephanie Torres	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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