336408433-2-27-2023-18-AS-KCLS-CPGVY8-20230228155044

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336408433
Report Date: 02/27/2023
Date Signed: 02/27/2023 01:37:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/27/2020 and conducted by Evaluator Rayshaun Nickolas

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200527083629

FACILITY NAME:	VISTA COVE AT RANCHO MIRAGE		FACILITY NUMBER:	336408433
ADMINISTRATOR:	JACK POYFAIR		FACILITY TYPE:	740
ADDRESS:	70201 MIRAGE COVE DRIVE		TELEPHONE:	(760) 324-4604
CITY:	RANCHO MIRAGE	STATE: CA	ZIP CODE:	92270
CAPACITY:	68	CENSUS: 50	DATE:	02/27/2023
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Rebecca Giorando, Director of Resident Services		TIME COMPLETED:	01:43 PM

ALLEGATION(S):

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Resident sustained multiple pressure injuries while in care.
Facility staff are not dispensing medications as prescribed.
Facility staff mismanaged resident's medication.
Facility is not kept at a comfortable temperature.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with Rebecca Giorando and explained the purpose of the visit. The investigation consisted of interviews and reviewed facility file documents pertinent to the investigation.

Allegation #1: “Resident sustained multiple pressure injuries while in care”. The reporting party alleged resident #1 (R1) had pressure wounds on both legs. Department staff interview with staff # 1 (S1) revealed that R1 had some leg ulcers, but they were not pressure wounds. LPA facility file review revealed that R1’s admission assessments note old skin tears on R1’s lower extremities. LPA facility file review also revealed that on May 20, 2020, facility staff notified R1’s physician about two (2) small sores on their right and left buttocks and requested any new order from R1’s physician. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

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-20200527083629

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: VISTA COVE AT RANCHO MIRAGE	FACILITY NUMBER: 336408433
	VISIT DATE: 02/27/2023

NARRATIVE

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Allegation #2: “Facility staff are not dispensing medications as prescribed”. LPA review of R1's Medication Administration Record (MAR) indicated that facility staff provided R1's medication as ordered by their physician. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Facility staff mismanaged resident's medication”. LPA compared R1’s MARs to their medication list referenced on their after-visit summary from medical appointments in March, April, and May, which revealed that both medications were added to the MARs, and facility staff provided said medications as ordered by their physicians. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #4 “Facility is not kept at a comfortable temperature”. The RP alleged that staff keeps the room vents closed, which does not allow property air ventilation, causing the room temperature to elevate. LPA interviews with facility staff revealed that the vents in R1’s room were not closed. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Rayshaun Nickolas	TELEPHONE: (951) 255-9516
LICENSING EVALUATOR SIGNATURE:	DATE: 02/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2023

LIC9099 (FAS) - (06/04)

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