331880999-6-26-2024-18-AS-RSTS-D6NQ3X-20240628114929

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880999
Report Date: 06/26/2024
Date Signed: 06/26/2024 12:27:36 PM

Unsubstantiated

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):

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Staff were sleeping while caring for the residents.

INVESTIGATION FINDINGS:

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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 were sleeping while caring for the residents. It was reported that on 01/10/2024, at approximately 1:30PM, a representative visited the facility and the staff member appeared like the staff member just woke up. It was reported that staff member’s hair and clothes were disheveled. Administrator denied that staff members sleep during the time period from 1-3 PM. Administrator stated staff complete chores and housekeeping around the facility. Information obtained from interviews with staff also denied that they sleep during their shift. Staff members corroborated that they are expected to complete tasks and continue providing assistance to residents as needed. During interviews with the residents, it was stated they have not observed any staff member sleeping while working. Residents reported they are still able to get assistance during the time period of 1:00PM to 3:00PM.

Unsubstantiated

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)

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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

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Based on interviews with staff members, residents, and additional witnesses, observation, and records review, the allegation that staff were sleeping while caring for the residents is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

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)

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