331880734-7-30-2021-18-AS-NBRN-CU6Q7X-20230728115552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880734
Report Date: 07/30/2021
Date Signed: 07/30/2021 01:11:45 PM

Unsubstantiated

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
04/26/2021 and conducted by Evaluator Amy Goldenberg

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210426161704

FACILITY NAME:	GLADWELL RANCHO MIRAGE		FACILITY NUMBER:	331880734
ADMINISTRATOR:	MARIGER, VICKI		FACILITY TYPE:	740
ADDRESS:	34560 BOB HOPE DRIVE		TELEPHONE:	(760) 770-7737
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	142	CENSUS: 81	DATE:	07/30/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jonathan Karp, Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Resident fell while in care.

INVESTIGATION FINDINGS:

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cThis unannounced visit conducted by Amy Goldenberg and Anna Bueno, Licensing Program Analyst (LPAs), is being conducted to conclude this agency’s investigation into the complaint allegation mentioned above.

During the course of the investigation LPA reviewed resident notes for R1 dated 10/03/2020 through 10/22/2020, one incident report dated 10/15/2020, and conducted interviews with three employees. It is alleged that R1 had a fall while in care and sustained scrapes and bruises on his knees. LPA learned the following information: The date of injury is unknown. R1 resided in the memory care unit of the facility from 10/03/2020 through 10/20/2020. Review of resident notes and the incident reported do not reveal that R1 fell while in care. Interviews conducted did not confirm that R1 had an injury or fall while in care at the facility and sustained scrapes and bruises on his knees.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

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-20210426161704

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: GLADWELL RANCHO MIRAGE	FACILITY NUMBER: 331880734
	VISIT DATE: 07/30/2021

NARRATIVE

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Based on the aforementioned, there is not enough available evidence to corroborate or refute the allegation. We have found the complaint allegation is unsubstantiated, although the allegation may have happened or is valid: there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report is being reviewed with and a copy is being furnished to Executive Director Jonathan Karp.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy Goldenberg	TELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 07/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2021

LIC9099 (FAS) - (06/04)

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