336403366-7-14-2022-18-AS-JESL-CHKTNP-20220823145304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:30:01 PM

Substantiated

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
07/06/2022 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220706102318

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: 130	DATE:	07/14/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Patrick Mcadoo Morton - Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility did not provide a safe environment for resident's in care.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation with the above allegation. LPA Colvin met with Administrator Patrick Mcadoo Morton and Memory Care Director Bobbie Rodgriguez. Below is a summary of the findings of the investigation:

Regarding allegation "Facility did not provide a safe environment for resident's in care": LPA Colvin interviewed staff and relevant parties as well as reviewed the facility's file and documents for resident (R1). LPA Colvin confirmed through record review and interviews that R1 began exhibiting increased aggressive behavior towards staff and residents two months prior (6/8/22), which included hitting, kicking, and spitting. While Administrator and Memory Care Director state that they reached out to R1's Public Guardian and doctor for assistance, the facility otherwise failed to act to protect the other residents until 7/1/22 when R1 was placed on a psychiatrict hold. Since R1's recent psychiatric hold on 7/1/22 and 7/5/22, the facility has issued an eviction notice based on R1's behavior.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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-20220706102318

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: 07/14/2022

NARRATIVE

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From 6/8/22 until 7/1/22, R1's file contains no less than 10 staff notes of R1 being physically violent with both staff and residents. Interviews and notes additionally show that residents were in fear of R1, which would prevent them from moving about the facility freely, as R1 would verbally and physically attack residents without provocation.

Therefore, based on record review and interview, the allegation "Facility did not provide a safe environment for resident's in care." is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Administrator Patrick Mcadoo Morton during the exit interview.

****Due to technical issues, reports were signed with ink signatures after they were printed. Facility maintains original copy while LPA maintains a photocopy of the report.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20220706102318

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/14/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/15/2022 Section Cited CCR 87468.1(a)(2)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agrees to re-evaluate how management are notofied of resident's potentially dangerous behavior as well how this is to be addressed. Licensee to provide LPA Colvin with updated facility policy on how violence/aggression is documents, reported, and handled by staff to ensure safety of
	8 9 10 11 12 13 14	Based on record review and interview, the Licensee did not comply with the above regulation with at least one aspect of the facility. R1 was physically and verbally aggressive with multiple residents for nearly 2 months prior to the facility having R1 removed. This was an immediate safety risk to residents.	8 9 10 11 12 13 14	staff and residents. Facility policy due by Plan of Correction date of 7/15/22.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal Colvin	TELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC9099 (FAS) - (06/04)

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