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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880734
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:56:31 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2021 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210302135250
FACILITY NAME:GLADWELL RANCHO MIRAGEFACILITY NUMBER:
331880734
ADMINISTRATOR:MARIGER, VICKIFACILITY TYPE:
740
ADDRESS:34560 BOB HOPE DRIVETELEPHONE:
(760) 770-7737
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:142CENSUS: 114DATE:
05/22/2023
UNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Monique Moreira, Executive DirectorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility staff is financially abusing resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegation. LPA met with Executive Director Monique Moreira and explained the purpose of the visit. Department staff investigated this allegation.

The allegation alleged that the reporting party (RP) shares a bank account with resident # 1 (R1) and noticed that R1 was writing checks to unknown individuals. Department staff interview with the RP revealed that they have access to R1’s bank account and noticed that two checks were written to two (2) individuals. The RP stated that they do not know either of these people. The RP stated that they questioned whether or not the signature on the checks was R1’s signature. The RP stated that both checks were cashed. The RP stated that R1 accuses people of stealing from them.

Department staff interview with the Executive Director (ED) revealed that on March 12, 2021, the RP brought two (2) check images to the ED that were cashed from R1’s bank account. ED stated that on February 9, 2021,
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
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 5
Control Number 18-AS-20210302135250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: GLADWELL RANCHO MIRAGE
FACILITY NUMBER: 331880734
VISIT DATE: 05/22/2023
NARRATIVE
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, a check was written to one (1) individual for $100.00. The ED stated that R1 rarely leaves their apartment and cannot leave the building unassisted. The ED stated that due to finding this check, the RP began to look for other questionable checks that cleared R1's bank account. The ED stated that the RP discovered that on November 11, 2020, another check was written for $150.00 to staff # 1 (S1). ED stated that on March 1, 2021, at 2:00 p.m., they and a manager at the facility spoke with S1 regarding the cashed check for $150.00. The ED stated that S1 confirmed receiving a $150.00 check from R1. The ED stated that S1 stated the $150.00 was a repayment for purchasing items at R1’s request, using S1's own money. The ED stated that they asked S1 if they were aware of the facility’s policy about not accepting money from residents, and S1 confirmed that they were aware of the policy. The ED asked S1 if they knew the name of the individual who received the other check for $100.00. The ED stated that S1 stated they knew someone with the same first name; however, the last name of the individual they know is different. The ED stated that the other check for $100.00 was written to S1’s boyfriend. The ED confirmed that S1’s boyfriend did not live in the facility or work at the facility. The ED stated that S1 denied that they asked for any money at any time. The ED and manager went to speak to R1. ED stated that R1 denied knowingly giving anyone in the community a check. The ED stated that R1 denied asking anyone in the community to purchase items for R1 at the store. The ED stated that for violating the facility’s policy, S1 is no longer an employee.

Based on the evidence gathered during the investigation, the above allegation 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.

An exit interview was conducted where a copy of this report (LIC 9099), LIC 9099D, and appeal rights were discussed and provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210302135250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: GLADWELL RANCHO MIRAGE
FACILITY NUMBER: 331880734
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/30/2023
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities (a)(3)

(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money ...
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The facility shall submit proof of reimbursement to R1 for the stolen monies to the regional office (RO). The POC due date is 05/30/2023.
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This requirement was not met, as evidenced by the following:

Based on interviews, the facility did not ensure that R1’s checkbook was safeguarded from S1, which posed a potential health, safety, and personal rights violation to persons in care.
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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: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2021 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210302135250

FACILITY NAME:GLADWELL RANCHO MIRAGEFACILITY NUMBER:
331880734
ADMINISTRATOR:MARIGER, VICKIFACILITY TYPE:
740
ADDRESS:34560 BOB HOPE DRIVETELEPHONE:
(760) 770-7737
CITY:RANCHO MIRAGESTATE: CAZIP CODE:
92270
CAPACITY:142CENSUS: 90DATE:
05/22/2023
UNANNOUNCEDTIME BEGAN:
11:43 AM
MET WITH:Monique Moreira, Executive DirectorTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility staff do not dispense medication as prescribed.
Facility staff do not treat resident with dignity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Executive Director Monique Moreira and explained the purpose of the visit. Department staff investigated these allegations.

Allegation #1 “Facility staff do not dispense medication as prescribed”. The allegation alleged that an unknown facility staff member was not providing resident #1’s (R1’s) medication on time. Department staff interview with the Executive Director (ED) revealed that the ED denied this allegation. The ED stated that R1’s medications are administered with two (2) caregivers to witness the administration. The ED stated that R1 would take the medication and still report that they never received it. The facility file review of R1's Medication Administration Records (MARs) conducted by department staff revealed that the physician's medication orders matched R1's MARs, and all medications were administered as prescribed. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20210302135250
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: GLADWELL RANCHO MIRAGE
FACILITY NUMBER: 331880734
VISIT DATE: 05/22/2023
NARRATIVE
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Allegation #2 “Facility staff do not treat resident with dignity”. The allegation alleged that a facility staff member was very rude to R1. Department staff interview with the ED revealed that the ED denied this allegation. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means 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 and copy of this report was provided.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun NickolasTELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5