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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 01/06/2023
Date Signed: 01/06/2023 04:13:03 PM

Unsubstantiated


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
12/27/2022 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20221227143725
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: 126DATE:
01/06/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Director of Nursing, Carminia MezaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Facility staff not providing adequate food service.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the fscility on 01/06/2023 at 2:30 p. m. in order to conduct an investigation into the above allegation. LPA met with Director of Nursing, Carminia Meza, who was informed of the purpose of the visit.

During the visit, LPA conducted interviews, conducted observations, and collected documentation as it pertained to the allegation. It was alleged that R1 has not been provided food in at least (2) weeks. LPA conducted interview with nursing director who denied the allegation, and stated that the resident had refused to eat dinner for (3) days from the period of 12/26/2022 to 12/28/2022, but had eaten breakfast and lunch on these days. Meza stated that R1 had requested a tray service to their room due to resident reporting feeling ill. LPA reviewed incident report dated 12/28/2022 where R1 was transferred out due to feeling ill. LPA reviewed dotor's note as the result of the visit stating that R1 should receive meals in their room. However, LPA also reviewed doctors note where it was stated that the previous order was "voided" and that R1 was capable of eating meals in the dining room. Meza stated this was after the facility informed R1 that they would need to pay an extra fee for this. LPA interviewed the resident who denied the allegation stating that the it had been "blown out of proportion". LPA was unable to find any evidence of R1 being without food for (2) weeks.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
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 3
Control Number 18-AS-20221227143725
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: 01/06/2023
NARRATIVE
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Therefore the allegation is unsubstantiated. A finding of unsubstantiated means that although the allegation is valid, the preponderance of the evidence standard has not been met.

An exit interview was conducted where this report was reviewed and provided to Carminia Meza.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3