336403366-5-30-2024-18-AS-TDAN-D8LMQP-20240829094900

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 05/30/2024
Date Signed: 05/30/2024 02:53:38 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
05/21/2024 and conducted by Evaluator Sara Martinez

COMPLAINT CONTROL NUMBER: 18-AS-20240521122020

FACILITY NAME:	WINDSOR COURT ASSISTED LIVING		FACILITY NUMBER:	336403366
ADMINISTRATOR:	AURELIEN FRUIT		FACILITY TYPE:	740
ADDRESS:	201 S. SUNRISE WAY		TELEPHONE:	(760) 327-8351
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	130	CENSUS: 130	DATE:	05/30/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Aurelien Fruit		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff did not prevent the residents from engaging in a physical altercation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sara Martinez made an unannounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA was granted entry and met with Administrator Aurelien Fruit who was informed of the purpose of the visit and the elements of the allegation. During today's visit, LPA toured the facility, conducted staff and resident interviews, and reviewed documentation pertinent to Resident One (R1) and Resident Two (R2).

Regarding the allegation “Staff did not prevent the residents from engaging in a physical altercation” it was reported a physical altercation occurred between R1 and R2 on May 17, 2024. R2 was sent to urgent care due to injuries sustained to the back of the head and R1 had a bruise on their left eye but refused medical treatment. Based on interviews conducted, R2 walked into R1’s room and initiated the physical altercation due to a closet door being left open. R2 reported R1 had used their cane to hit R2 on the back of their head.

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: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

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-20240521122020

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: 05/30/2024

NARRATIVE

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R2 walked to the facility’s front desk and informed staff of their injury and requested emergency services. Interviews revealed when staff entered R1’s room after the physical altercation, they noticed R1’s dresser drawer was open. They observed blood on the edge of the drawer and directly below the dresser drawer was a pool of blood on the carpet. It was reported when staff entered R1’s room, R1 had two canes, one on the wall and one on the floor with no traces of blood on either canes. Interview with R1 revealed R2 entered R1’s room and started hitting R1. R1 reported they are not aware of a prior verbal or physical dispute with R2 that initiated the physical altercation. R1 and R2 have two separate rooms but share one bathroom. Administrator Fruit reported arrangements were made to have R2 move into a different room when they returned from urgent care but R2 refused to move rooms. Interviews conducted with R1 and R2 revealed neither of the residents wanted to move rooms after the physical altercation. R2 reported no verbal disputes or physical altercations with R1 after May 17, 2024.

Interviews and records review revealed R1 and R2 did not have any prior incidents involving physical aggression or verbal disputes while residing in the facility. Records review of Physician’s Report for R1 revealed R1 is able to perform their activities of daily living (ADL) with no supervision or assistance from staff which includes bathing self, grooming self, feeding self, and care for own toileting needs and R1 does not have a history of aggressive behavior. Physician’s Report for R2 revealed R2 is able to perform their activities of daily living (ADL) with no supervision or assistance from staff which includes bathing self, grooming self, feeding self, and care for own toileting needs. It is recorded R2 has aggressive behaviors “at times”. Interview with staff one (S1) reported after R1 and R2’s physical altercation, staff were instructed to conduct daily observations and monitoring during each shift and document R1 and R2’s behaviors. Staff interviews corroborated staff were informed and implemented a plan to increase monitoring of R1 and R2’s interactions. Staff also reported the plan included redirection of interactions between R1 and R2 when necessary.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20240521122020

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: 05/30/2024

NARRATIVE

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Records review revealed on May 20, 2024, staff began documenting R1 and R2’s behaviors daily based on a number system indicating aggressive behaviors observed. Zero (0) indicated no aggressive behavior observed, one (1) indicated yelling observed, two (2) indicated cursing was observed, and three (3) striking out or being physically aggressive was observed. R1 and R2 had zeros documented daily for each shift from May 20, 2024 to May 30, 2024.

Based on interviews and records review, staff did not have any indication that the interaction between the two residents was escalating prior to R2 entering R1’s room to prevent the physical assault. Therefore based on interviews and records review, the allegation “Staff did not prevent a resident from physically assaulting another resident in care” has been deemed unsubstantiated at this time. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided.

An exit interview was conducted with Administrator Fruit and a copy of this report, LIC 811, and LIC 9099C was provided.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Sara Martinez	TELEPHONE: (951) 605-0913
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2024

LIC9099 (FAS) - (06/04)

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