336403366-8-7-2020-18-AS-EMAN-BSUUYQ-20200826160019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 08/07/2020
Date Signed: 08/07/2020 04:39:39 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/20/2020 and conducted by Evaluator Natalie Gayoso

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200420170715

FACILITY NAME:	WINDSOR COURT ASSISTED LIVING		FACILITY NUMBER:	336403366
ADMINISTRATOR:	BRITTANY HOLM		FACILITY TYPE:	740
ADDRESS:	201 S. SUNRISE WAY		TELEPHONE:	(760) 327-8351
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	130	CENSUS: 93	DATE:	08/07/2020
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Brittany Holm - Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Inadequate staffing to meet resident's needs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso contacted the facility via telephone due to COVID-19 to conclude investigation and deliver findings. LPA identified herself and discussed the purpose of the call and the elements of the allegation with Administrator Brittany Holm

The investigation consisted of file review and interviews with relevant parties. The allegation indicates inadequate staffing to meet resident's needs. Interview with Resident #1 (R1) indicated he became upset with staff when told he would have to wait for his medication. R1 stated he only waited a few minutes and Staff #1 (S1) administered medication on time. R1 admits to getting upset when staff is not immediately available and files a complaint with the Department. Interview with S1 stated he was addressing an emergency call regarding another resident that required 2 staff members assistance, when R1 request medication. S1 stated R1 only had to wait 10 minutes, but that medication was still dispensed on time.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

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-20200420170715

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: WINDSOR COURT ASSISTED LIVING	FACILITY NUMBER: 336403366
	VISIT DATE: 08/07/2020

NARRATIVE

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This agency has investigated the complaint alleging that inadequate staffing to meet resident's needs. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened, and is without a reasonable basis.

No deficiencies were cited during this visit. An exit interview was conducted with the Ms. Holm via telephone and a copy of this report was provided via email. Report with facility signature was obtained.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 08/07/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/07/2020

LIC9099 (FAS) - (06/04)

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