336403366-8-2-2024-18-AS-TDAN-D86U4Y-20240815151552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 08/02/2024
Date Signed: 08/02/2024 02:32:00 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
06/02/2021 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20210602143558

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: 127	DATE:	08/02/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Director of Nurses - Carmina Meza		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility staff over-medicated resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez arrived unannounced to the facility to conclude the investigation into the allegation listed above. LPA met with Director of Nurses Carmina Meza and explained the purpose of the visit. LPA’s complaint investigation consisted of a tour of the interior/exterior areas of the facility, observations, interviews with staff and residents, and records review of requested pertinent documents.

Regarding the allegation “Facility staff over-medicated resident”, it was reported Resident One (R1) was overmedicated and had in their possession half a tablet of medication that did not belong to R1. Records review of facility progress report dated 05/30/2021 shows R1 was having a behavior in the AM and refused to take their AM medication. R1’S Power of Attorney (POA) was called and POA stated they would arrive to the facility at 1:00pm. Staff contacted 911 services at 10:50am to seek additional assistance due to safety concerns for staff and other residents in care. Palm Springs PD arrived to the facility to provide assistance at approximately 12:30pm.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

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-20210602143558

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: WINDSOR COURT ASSISTED LIVING	FACILITY NUMBER: 336403366
	VISIT DATE: 08/02/2024

NARRATIVE

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R1 requested two PRNs for pain management. One PRN was given at 12:54pm and the second PRN was given at 01:01pm. R1’s POA arrived at approximately 1:30pm and R1 reported to the POA and Palm Springs Officer the facility was giving R1 medication that did not belong to them. During the initial visit to the facility on 06/09/2021, a medication count was conducted for R1 and Resident Two (R2) and found no discrepancies with the pill count and documentation on the medication administrator record (MAR). Interview with three (3) staff deny R1 being over medicated or R1 being administered medication that was not prescribed to them. Interview with R1 revealed they do not take medication that is not prescribed to them and does not store extra medication in their room or personal belongings. Records review of R1’s MAR shows staff had documented the time and day the two PRNs were given to R1 on 05/30/2021. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to Director Of Nurses Meza.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2024

LIC9099 (FAS) - (06/04)

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