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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880947
Report Date: 03/08/2022
Date Signed: 03/08/2022 12:41:20 PM

Document Has Been Signed on 03/08/2022 12:41 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: 86DATE:
03/08/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Jones Ntekim, AdministratorTIME COMPLETED:
12:45 PM
NARRATIVE
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Licensing Program Analyst (LPA), Jesse Gardner arrived to the facility to conduct a health and safety check of residents in care. LPA met with Administrator Jones Ntekim. Mr. Ntekim advised that there were a total of 86 residents in care within the facility.

LPA toured the facility with Mr. Ntekim. During the tour, LPA found that residents have the required food supply, and LPA made no observations of violations related to the overall health and safety of the residents, per Title 22.

LPA reviewed, and gathered Staff Oliver Walker's file, as well as other pertinent documents in relation to Mr. Walker during the visit.

Mr. Walker's duties at the facility were that they support clients with Assistance with Daily Living (ADL's), daily reminders for clients, etc. Mr. Walker was not a licensed professional giving medical care to clients; thus, Mr. Walker needed a completed background clearance to conduct their duties in the facility.

Upon review of employee roster through Guardian, it was found that Mr. Walker had not had a completed background clearance. Per Title 22, division 6 chapter 1 article 3, a Type A deficiency was issued. Mr. Walker had been terminated 3/8/22 for an unrelated incident.

An exit interview was discussed with Mr. Ntekim, and a copy of this report, along with copies of LIC809-D and Appeal Rights were provided.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2022
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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Document Has Been Signed on 03/08/2022 12:41 PM - It Cannot Be Edited


Created By: Jesse Gardner On 03/08/2022 at 12:27 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: 03/08/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/09/2022
Section Cited
CCR
80019(e)(1)

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CRIMINAL RECORD CLEARANCE:(e)All individuals subject to a criminal record..in a licensed facility..(1)Obtain a California clearance..This requirement was not met as evidenced by:
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Mr. Walker had been terminated on 3/8/22, and staff will review regulation and self-certify by submitting to LPA by 3/9/22 that the regulation was understood.
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Based on LPA's record review, the Licensee did not ensure a clearance was completed prior to the start of employment of Mr. Walker. This poses an immediate health and safety risk to 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:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2022


LIC809 (FAS) - (06/04)
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