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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 05/16/2023
Date Signed: 05/16/2023 03:09:18 PM

Substantiated


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
05/12/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230512141034
FACILITY NAME:WINDSOR COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:PATRICK MCADOO MORTONFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 129DATE:
05/16/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Aurelien Fruit, Administrator TIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Licensee allowed staff without criminal record clearance to work in facility.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to commence a complaint investigation regarding the allegation(s) listed above. LPA met with Administrator Aurelien Fruit and explained the purpose of the visit and the elements of the allegations. The allegation was investigated, the investigation consisted of observation, interviews and record review.

Regarding the allegation of Licensee allowed staff without criminal record clearance to work in the facility.
LPA requested a copy of the staff schedule and was provided a list of staff that were working at the facility. Per the list there were 27 staff working, of the 27 staff, LPA observed for Staff #1 (S1) that has obtained fingerprint clearance but was not associated to the facility. Based on observation and record review the allegation of licensee allowed staff without criminal record clearance to work in facility is SUBSTANTIATED.

An exit interview was conducted and a copy of this report, appeal rights, LIC621BG were provided to Aurelien Fruit, Administrator.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
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 5
Control Number 18-AS-20230512141034
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/17/2023
Section Cited
CCR
87355
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87355 Criminal Record Clearance(b) Prior to the Department issuing a license, the applicant, administrator and any adults other than a client, residing in the facility shall have a criminal record clearance or exemption. This requirement is not met as evidenced by: Based on
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The Licensee agrees to associate S1 to the facility by 5pm on the due date indicated.
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observation, and interview the licensee did not ensure that Maria A. was associated to the facility prior to beginning their employment. This poses an immediate healthy, safety and personal rights risk to persons in care.
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CCR
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20230512141034
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: 05/16/2023
NARRATIVE
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The continuation page needed to be amended to remove an allegation, as it can be found on the 9099A page.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
05/12/2023 and conducted by Evaluator Javina George
COMPLAINT CONTROL NUMBER: 18-AS-20230512141034

FACILITY NAME:WINDSOR COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:PATRICK MCADOO MORTONFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 129DATE:
05/16/2023
UNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Aurelien Fruit, Administrator TIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Staff failed to administer resident's medication as prescribed.
INVESTIGATION FINDINGS:
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Allegation #2 Staff failed to administer resident's medication as prescribed.

Resident #1 (R1) sustained a fall which resulted in being prescribed pain management medication. The prescribed medication was to be given as needed (PRN), every three hours for pain. Interviews conducted revealed that R1's Power of Attorney (POA) gave the directive for staff to administer the medication around the clock as R1 would not ask for the medication, as R1 was declining. R1 did not receive a dosage of their medication in the evening on 1/22/2023, as when staff went to their room they were observed to be sleeping, and appeared to be comfortable. Staff #1 (S1) did not observe any visible symptoms of R1 being in pain such as grimacing and grunting, resulting in the medication not being administered. In addition the medication prescribed was a PRN, (to be given as needed). There was no doctor's order to support the request from the POA. even though the POA does have the authority to make decisions on behalf of R1 and ensure that they are comfortable the allegation is UNFOUNDED, as the was not a physician's order to support the request. A finding that the complaint is unfounded means that the allegation is false, could not have happened,
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20230512141034
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: 05/16/2023
NARRATIVE
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and/or is without a reasonable basis. Therefore, the department had there dismissed the complaint.

An exit interview was conducted and a copy of this report was provided to Aurelien Fruit, Administrator,
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5