331880999-6-26-2024-18-AS-RSTS-D6NQ3W-20240628114922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880999
Report Date: 06/26/2024
Date Signed: 06/26/2024 12:28:08 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
02/07/2024 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20240207122858

FACILITY NAME:	MD PREMIER CARE HOME		FACILITY NUMBER:	331880999
ADMINISTRATOR:	DOLHA, MIRCEA		FACILITY TYPE:	740
ADDRESS:	45911 PASEO CORONADO		TELEPHONE:	(949) 335-2364
CITY:	INDIAN WELLS	STATE: CA	ZIP CODE:	92210
CAPACITY:	6	CENSUS: 4	DATE:	06/26/2024
		UNANNOUNCED	TIME BEGAN:	11:20 AM
MET WITH:	Administrator, Mircea Dolha		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff denied the residents visitations during specific hours.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Mircea Dolha and explained the purpose of the visit and the elements of the allegation. The investigation consisted of interviews with staff members, residents, and additional witnesses, observation, and records review.

On 02/07/2024, Community Care Licensing received a complaint alleging that Staff denied the residents visitations during specific hours. It was reported that on 01/10/2024, at approximately 1:30 PM, a representative visited the facility and was advised that the facility was currently closed. During interviews conducted with additional witness, it was reported that visitor arrived at the facility at approximately 1:30PM. The staff member advised the visitor that the facility is closed during the time period of 1PM-3PM. The visitor explained their occupation and which resident they were there to see. Without hesitation, the staff member allowed the visitor in. Administrator, Mircea Dolha stated the time indicated for no visitors is typically nap time for residents as it is right after lunch. Administrator stated that staff members complete chores during that time as well.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

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 2

Control Number 18-AS-20240207122858

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MD PREMIER CARE HOME	FACILITY NUMBER: 331880999
	VISIT DATE: 06/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Additional information obtained during interviews with staff advised there was no denial once the visitor explained their purpose for visiting the facility. Information obtained from interviews with residents indicated there are no issues with visitation and they are allowed visitors whenever they chose. During record reviews, LPA reviewed the sign posted in the front of the facility, which listed business Hours as the following: Sunday through Saturday, 9:00am to 6:00pm. Information obtained stated the facility is closed every day from 1:00pm to 3:00pm. LPA reviewed the facility’s program plan, the signed admissions agreement, and the Written Record of Care. The information regarding visitation hours can be found under “Visitation Hours” and “Policies Concerning Family Visits,” which list the visitation hours. Hours outside the scheduled visitation can be requested and approved in advance. All documents were signed by each resident and their responsible party.

Based on interviews with staff members, residents, and additional witnesses, observation, and records review, the information obtained indicated that the staff member followed the approved plan of operation, but still made provisions for the representative to visit the facility without delay. Therefore, the allegation that Staff denied the residents visitations during specific hours is unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report was provided to Administrator, Mircea Dolha.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2