336407087-12-10-2021-18-AS-JESL-CQF7R5-20230330215257

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336407087
Report Date: 12/10/2021
Date Signed: 12/10/2021 02:42:22 PM

Unfounded

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
12/08/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211208114153

FACILITY NAME:	COPPER CANYON SENIOR CARE		FACILITY NUMBER:	336407087
ADMINISTRATOR:	TELECIA COOKE		FACILITY TYPE:	740
ADDRESS:	37225 JEROME LANE		TELEPHONE:	(951) 677-1349
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	8	CENSUS: 4	DATE:	12/10/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Telecia Cooke		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee wilfully created an act of isolation by denying access to the residents/facility from an authorized representative.
Licensee created a hostile environment.
Licensee prevented a visitor from leaving.
Licensee made unnecessary law enforcement contact.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to investigate and deliver findings for the allegations (s) listed above. LPA met with Administrator Telecia Cooke and explained the purpose of the visit and elements of the allegations. The investigation consisted of observation, interviews, and record review.
Allegation: Licensee willfully created an act of isolation by denying access to the residents/facility from an authorized representative. LPA conducted interviews and documentation review, which revealed that the representative arrived at the facility and refused to comply with the facility’s covid-19 screening protocol. Per Administrator Telecia and Caregiver Vicky the screening is conducted right outside the front door, prior to entering inside the facility. When the request was made by the caregiver on duty at the time of the incident, the representative refused and stated that they were exempt from being screened as they had a right of entry. Therefore, the allegation of is Licensee willfully created an act of isolation by denying access to the residents/facility from an authorized representative. UNFOUNDED.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

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-20211208114153

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: COPPER CANYON SENIOR CARE	FACILITY NUMBER: 336407087
	VISIT DATE: 12/10/2021

NARRATIVE

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Allegation: Licensee created a hostile environment. LPA conducted interviews and reviewed documentation. The documentation reviewed revealed the administrator Telecia making a reasonable and common request of asking for the representative to step outside, so that the caregiver on duty could complete the covid screening for visitors. The administrator attempted to explain the reason, but the representative began to raise their voice. The representative got out their cell phone and began recording the Administrator, and the administrator in turn did the same. The documentation reviewed does not support the administrator creating a hostile environment. Therefore, the allegation is UNFOUNDED.
Allegation: Licensee prevented a visitor from leaving.
LPA reviewed documentation which revealed the representative was instructed by their Supervisor via telephone to go to their car. At that time the representative stated that they were going to go to their car and wait for the police to arrive. Additionally, the documentation did show the Administrator walking outside, at a reasonable distance and was requesting the representative’s supervisor’s contact information. The representative attempted to close their car door and began honking their horn with the Administrator standing there. The Administrator moved out of the way. Additionally, the Administrator had requested for the representative to leave the premises multiple times. Therefore, the allegation is UNFOUNDED.
Allegation: Licensee made unnecessary law enforcement contact.
LPA interviewed Administrator Telecia stated that she did contact law enforcement via the non-emergency line because the representative became aggressive, did not comply with being screened and refused to exit her home, so that proper covid protocols could be followed. Administrator stated that the facility has not had any positive covid cases and would like to keep it that way. Administrator could not see the harm in asking a few questions and taking a temperature. Additionally, documentation reviewed supported what administrator reported to LPA George as well as the on duty LPA. the allegation is UNFOUNDED. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. The department investigated and therefore dismissed the complaint.

An exit interview was conducted, and a copy of this report was provided to administrator Telecia Cooke.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 12/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/10/2021

LIC9099 (FAS) - (06/04)

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