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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 09/08/2020
Date Signed: 09/08/2020 03:38:17 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
08/04/2020 and conducted by Evaluator Susan Parker
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200804141212
FACILITY NAME:WINDSOR COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:BRITTANY HOLMFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 76DATE:
09/08/2020
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Robert BernalTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Inadequate staffing to meet residents needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst Susan Parker contacted the facility via telephone, due to COVID-19, to deliver the final complaint investigation report regarding the above allegation.

The investigation consisted of the following: LPA Parker interviewed the administrator, witness #1, 7 residents, 2 caregivers, reviewed staff notes, staff schedule and LPA received a resident roster.

The investigation revealed the following: In early August 2020, Administrator Brittany Holm utilized the services of a staff registry to assist the caregivers with providing care and supervision to the residents. LPA reviewed the staff schedule and verified there was 24/7 staffing. It was alleged that resident #1's toileting needs were not met in a timely manner. LPA Parker interviewed caregiver #1 (from the staff registry) and caregiver #2 (from the facility) who were on duty on 8/4/20 and the caregivers stated they responded to resident #1 and performed the duties they were asked to do. They could not recall a time when resident #1's toileting needs were not met. LPA interviewed 7 residents and the general opinion of the residents interviewed by LPA, is that staffing is adequate.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan ParkerTELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020
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-20200804141212
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: 09/08/2020
NARRATIVE
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Although the allegation may have happened, there is not a preponderance of evidence to prove the allegation occurred, therefore the allegation is Unsubstantiated.

Exit interview was conducted with Robert Bernal, Business Office Manager. A copy of this report was provided to him via email.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Susan ParkerTELEPHONE: (951) 897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 09/08/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 2