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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880947
Report Date: 09/02/2022
Date Signed: 09/02/2022 11:18:48 AM

Document Has Been Signed on 09/02/2022 11:18 AM - 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:NTEKIM, JONESFACILITY TYPE:
735
ADDRESS:19531 MCLANE STTELEPHONE:
(760) 778-2083
CITY:NORTH PALM SPRINGSSTATE: CAZIP CODE:
92258
CAPACITY: 92CENSUS: 91DATE:
09/02/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Administrator Jones NtekimTIME COMPLETED:
11:25 AM
NARRATIVE
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to the facility to follow up on an incident reported to the Department. LPA met with Administrator Jones Ntekim.

The Department was notified that on March 4, 2022, Staff 1 (S1) picked up Resident 1 (R1) from the facility and engaged in illicit drug use together. Interviews with R1 revealed S1 contacted R1 via Facebook Messenger and asked that R1 meet up with him. R1 stated S1 picked R1 up on the street in front of the facility, R1 got into the staff’s car and was asked if R1 wanted to go get high. R1 reported getting into the car and taking a hit of S1’s pipe. R1 returned to facility later that night. S1 was interviewed and confirmed that he had picked up R1 on the night of March 4, 2022 and that R1 engaged in illicit drug use with him.


The following day, March 5, 2022, S1 and R1 voluntarily consented to a drug test at the facility and both came back positive for Methamphetamine. The facility provided documentation which confirms the positive test results. S1 was suspended on March 5, 2022 and subsequently terminated from employment on March 7, 2022.


Based upon the above stated information and in accordance with Title 22 regulations, a citation is being issued as detailed on the LIC809D. An exit interview was conducted and a copy of this report, along with Appeal Rights was reviewed with and provided to Administrator Jones Ntekim.

SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/02/2022
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 09/02/2022 11:18 AM - It Cannot Be Edited


Created By: Jesse Gardner On 09/02/2022 at 10:47 AM
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: 09/02/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/03/2022
Section Cited
CCR
80065(a)

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Personnel Requirements: Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not being met as evidenced by:
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Licensee states that training will be conducted for all staff regarding appropriate staff and client interactions and submit proof of completion to LPA by POC date.
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Interviews revealed S1 picked up R1 from the facility and engaged in illicit drugs use. This posed an immediate health, safety and personal rights violation to resident 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:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022


LIC809 (FAS) - (06/04)
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