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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880947
Report Date: 08/17/2021
Date Signed: 08/17/2021 12:44:01 PM

Document Has Been Signed on 08/17/2021 12:44 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ROY'S DESERT SPRINGS ADULT RESIDENTIAL CAREFACILITY NUMBER:
331880947
ADMINISTRATOR:ARNETT, KIMBERLYFACILITY TYPE:
735
ADDRESS:19531 MCLANE STTELEPHONE:
(760) 778-2083
CITY:NORTH PALM SPRINGSSTATE: CAZIP CODE:
92258
CAPACITY: 92CENSUS: 75DATE:
08/17/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Denise Arellano - Cheif Financial Officer (CFO)TIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the Licensee's corporate office in order to investigate an open complaint (#18-AS-20210223131024). During LPA Colvin's investigation of the complaint, LPA Colvin observed some additional deficiencies. LPA Colvin met with Facility Representative and Chief Financial Officer (CFO) Denise Arellano. LPA Colvin advised Denise of the purpose of the visit.

During LPA Colvin's investigation of a complaint (#18-AS-20210223131024), LPA Colvin learned that the facility has all residents' funds combined in one bank account. LPA Colvin informed CFO Denise Arellano that resident funds must be kept separate as to ensure accurate accounting and safety of each residents' money. Deficiency cited. LPA Colvin additionally inquired as to if the corporation has a Surety Bond specific to the facility, as LPA Colvin observed prior to coming out to the location that there was none on file at Community Care Licensing (CCL) office. CFO Denise informed LPA Colvin that the corporation has Crime Policy, which is required for their liability insurance. LPA Colvin asked if this was specific to the facility or if this covered all of the Licensee's contracts. COO Melinda Drake, who was present for part of today's visit, stated that it covers all contracts for the License. LPA Colvin discussed the problem presented with this with CFO Denise, and inquired that if something catastrophic happened to all of the Licensee's contract, would this policy be enough to still protect the resident funds at Roy's. LPA Colvin was advised that it would not. Deficiency cited.

Lastly, LPA Colvin observed that CCL has on file for the facility's Program Plan that the facility planned on not handling any resident money. It was confirmed that this was a misunderstanding of the document (LIC400) as well as issues presented with the residents when their monthly funds from SSI were being managed elsewhere, and the facility ended up agreeing to manage their funds. All major facility program changes are to be reported to CCL in the form of either an updated Program Plan or amendment. Deficiency cited. Due to observations made by LPA Colvin, the facility was cited, and deficiencies noted on the LIC809D.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE: DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/17/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: ROY'S DESERT SPRINGS ADULT RESIDENTIAL CARE
FACILITY NUMBER: 331880947
VISIT DATE: 08/17/2021
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A copy of this report was provided along with LIC809D and appeal rights during the exit interview with Facility Representative and CFO Denise Arellano. LPA Colvin will be emailing a copy of the report to Administrator/Facility Director Jones Ntekin as well.

LPA Colvin additionally provided CFO Denise with blank copies of the Licensing forms for Surety Bond (LIC402) and Affidavit Regarding Client Funds (LIC400), which need to be completed and returned to CCL as soon as possible, along with either an updated Program Plan or added addendum to reflect all changes.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 08/17/2021 12:44 PM - It Cannot Be Edited


Created By: Crystal Colvin On 08/17/2021 at 12:08 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROY'S DESERT SPRINGS ADULT RESIDENTIAL CARE
FACILITY NUMBER: 331880947

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2021
Section Cited
CCR
80025(b)

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Bonding: (b) All licensees, other than governmental entities, who are entrusted to care for and control clients' cash resources shall file or have on file with the licensing agency, a bond issued by a surety company to the State of California as principal. This requirement was not met by:
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Licensee agrees to obtain a Surety Bond sufficient to the amount of funds expected to be held by the facility on behalf of residents. Licensee may reference 80025(c) for amounts required. Licensee to additionally complete form LIC402 and return with copy of valid Surety Bond to CCL by 8/31/21.
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Based on interviews, the Licensee did not comply with the above regulation with maintaining a surety bond for the facility. LPA Colvin leanred that the Licensee does not have a surety bond specifc to the facility for resident funds. This is a potential personal rights violation for all residents at the facility.
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Type B
08/31/2021
Section Cited
CCR80026(e)

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Safeguards for Cash Resources, Personal Property, and Valuables of Residents: (e) Cash resources, personal property, and valuables of clients shall be separate and intact... This requirement was not met as evidenced by:
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Licensee agrees to seperate all resident funds. Licensee may create individual bank accounts or keep all funds on facility ground and in seperate envelopes for each resident. Funds should be kept secure at all times. Licensee may self-certify to LPA Colvin what method was used once complete. Due 8/31/21
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Based on interviews, the Licensee did not comply with the above regulation with all resident funds held by facility. LPA Colvin learned that all resident funds are kept in a single bank account. This poses a potential personal rights violation to all residents for which the facility handles funds.
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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
LICENSING EVALUATOR NAME:Crystal Colvin
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2021


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 08/17/2021 12:44 PM - It Cannot Be Edited


Created By: Crystal Colvin On 08/17/2021 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ROY'S DESERT SPRINGS ADULT RESIDENTIAL CARE
FACILITY NUMBER: 331880947

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/17/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2021
Section Cited
CCR
80022(j)

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Plan of Operation: (j) Any changes in the plan of operation which affect the services to clients shall be subject to licensing agency approval and shall be reported as specified in Section 80061. This requirement was not met as evidenced by:
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Licensee agrees to submit either an updated Program Plan, or an amendment to the current Program Plan to CCL by the Plan of Correction date of 8/31/21. Licensee to additionally fill out and submit LIC402 to CCL by 8/31/21.
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Based on record review and interviews, the Licensee did not comply with the above regulation in one area (resident funds) of their Program Plan. LPA Colvin observed that in the facility's application they stated they would not handle resident funds, which they do. This is a potential personal rights risk to all residents.
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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
LICENSING EVALUATOR NAME:Crystal Colvin
LICENSING EVALUATOR SIGNATURE:
DATE: 08/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/17/2021


LIC809 (FAS) - (06/04)
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