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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 10/20/2023
Date Signed: 10/20/2023 10:13:25 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
09/15/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230915083849
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: 130DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Aurelien FruitTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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9
Staff did not provide a comfortable environment for resident
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA met with Administrator, Aurelien Fruit and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observation, interviews with staff members and residents, and record review.
On 09/15/2023, Community Care Licensing received a complaint stating that facility staff did not provide a comfortable environment for resident. In regards to the allegation that the staff did not provide a comfortable environment for resident, it was reported that Resident #1 (R1) had several incidents with R1’s roommate (R2). It was alleged that R2 was verbally abusive towards R1 and R2 used R1’s property without permission.
(Continued on LIC9099C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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 4
Control Number 18-AS-20230915083849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WINDSOR COURT ASSISTED LIVING
FACILITY NUMBER: 336403366
VISIT DATE: 10/20/2023
NARRATIVE
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(Continuation from LIC9099)

During LPA’s investigation, LPA was advised that the concerns were vocalized to Administrator and Administrator removed R2 from the shared room. R1 received a new roommate, R3. R1 and R3 had an incident where R1 came into the room and R3 was allegedly drinking his beverage. R1 addressed the new concerns to Administrator. Administrator then removed R3 from the room and reassigned another resident to the room. During interviews and record review, LPA concluded that the facility has made adjustments in a timely manner and acted in the best interest of the resident.

Based on LPA’s observation, interview conducted, and record reviews, the preponderance of evidence shows the allegations that staff did not provide a comfortable environment for resident is unfounded. This agency has investigated the complaint alleging staff did not provide a comfortable environment for resident. The Department has found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.



An exit interview was conducted, a copy of this report, appeal rights was provided to the Administrator, Aurelien Fruit as evidenced by his signature.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
09/15/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230915083849

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: 130DATE:
10/20/2023
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Administrator, Aurelien FruitTIME COMPLETED:
10:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident’s personal property
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/15/2023, Community Care Licensing received a complaint stating that facility staff did not safeguard resident’s personal property. In regards to the allegation that staff did not safeguard resident’s personal property. It was reported that the facility staff did not safeguard Resident #1’s (R1) personal property. LPA learned that the facility did not keep records of personal property logs due to the resident refusing. During interviews, LPA learned that there were not missing items, but rather the allegation that R3 was utilizing R1’s personal items. The facility removed the roommate per the request of R1. Facility indicated that they investigated all allegations that R1 has brought to the Administrator’s attention, the outcome of the complaints were deemed inconclusive.
(Continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20230915083849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: WINDSOR COURT ASSISTED LIVING
FACILITY NUMBER: 336403366
VISIT DATE: 10/20/2023
NARRATIVE
1
2
3
4
5
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12
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14
15
16
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32
(Continuation from LIC9099)

Based on the LPA’s observation, interviews conducted and records review. The preponderance of evidence shows the allegation of staff did not safeguard resident’s personal property unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, appeal rights was provided to the Administrator, Aurelien Fruit as evidenced by his signature.


SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen BanrasavongTELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4