336403366-1-10-2024-18-AS-JDHS-CZMQPK-20240119112050

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 01/10/2024
Date Signed: 01/10/2024 03:40:53 PM

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
10/26/2023 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20231026092156

FACILITY NAME:	WINDSOR COURT ASSISTED LIVING		FACILITY NUMBER:	336403366
ADMINISTRATOR:	PATRICK MCADOO MORTON		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:	01/10/2024
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Administrator, Aurelien Fruit		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not administer resident's medication in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to deliver findings for a complaint investigation regarding the allegations 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 10/26/2023, Community Care Licensing received a complaint stating that the staff did not administer resident’s medication in a timely manner. In regards to the allegation that the staff did not administer medication for Resident 1 (R1), it was reported that the facility did not apply and give R1 their prescribed treatment. LPA Banrasavong spoke to R1 who confirmed that they were provided their treatment twice.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

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-20231026092156

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: 01/10/2024

NARRATIVE

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It was corroborated by the R1’s Medication Administrator Record (MARS) which showed that the first application of the treatment was administrated on October 13, 2023. The second application for the cream was administered on October 21, 2023, which was according to doctor’s orders. Information obtained from staff interviews indicated that the medication was given to R1 which followed the doctor’s orders. After the medication was applied, the staff initialed that it was dispersed to R1.
Based on LPA’s observation, interview conducted, and record reviews, the preponderance of evidence shows that the allegations that Staff did not administer resident's medication in a timely manner is unfounded. 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.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-248-0319
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2024

LIC9099 (FAS) - (06/04)

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