336410270-4-28-2023-18-AS-JDHS-CS7VD8-20230526162019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410270
Report Date: 03/24/2023
Date Signed: 04/28/2023 04:21:53 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
05/13/2020 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200513111528

FACILITY NAME:	CHRISTMAS COTTAGE		FACILITY NUMBER:	336410270
ADMINISTRATOR:	VICTORIA J. SARSON		FACILITY TYPE:	740
ADDRESS:	330 S. SAN JACINTO ST		TELEPHONE:	(951) 765-1840
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	14	CENSUS: 13	DATE:	03/24/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	ADMINISTRATOR, KATHLEEN HYLAND.		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

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Facility staff are not administering resident's medications according to doctor's orders.
Resident eloped from facility.
Staff are not being truthful with resident's authorized representative regarding incidents.
Staff financially abusing resident.

INVESTIGATION FINDINGS:

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On March 24, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the above facility and met with Administrator. The visit was conducted in order to deliver findings for the listed allegations and conclude the investigation. The investigation consisted of staff and resident interviews, recorded reviews, and observations.
On May 13, 2020, Community Care Licensing received information that Facility staff are not administering Resident's, (R1) medications according to doctor's orders. Information obtained revealed Resident (R1) was previously taking a specific medication (M1). In February 2020, the Resident's primary care doctor discontinued the medication according to information obtained from interviews. Other information obtained stated that in April 2020 the Resident was often groggy, sleeping excessively, and not feeling well. Additionally, it was noticed Resident’s hands shaking. Information obtained stated it is believed the Staff have started to give R1 the discontinued medication again. Information provided also, stated that R1 was only taking medications that were prescribed. Additional information obtained from interviews stated R1 was only receiving prescribed medications. Information obtained from interviews, and record reviews showed inconstancies and there was not enough documentation to demonstrate that the listed allegations did or did not occur. Therefore, after LPA's assessment of staff and resident interviews, and record reviews there was not a preponderance of the evidence to demonstrate if the listed allegations did or did not occur. Therefore, "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, therefore the outcome of this investigation is deemed UNSUBSTANTIATED. An 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 a copy of this report was given to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

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-20200513111528

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: CHRISTMAS COTTAGE	FACILITY NUMBER: 336410270
	VISIT DATE: 03/24/2023

NARRATIVE

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Regarding allegation # 2, Resident eloped from facility. Information attained from the Reporting Party (RP), stated the Resident went missing and Hemet Police Department (PD), found Resident blocks away from the facility. Information from Facility Staff stated that the Resident was not blocks away but in the parking lot of the facility. Additional information from Facility Staff stated the facility did not report the Resident missing because he was not missing. Information from Hemet PD stated there was no report documenting the incident because the Resident was not reported missing and/or was not unaccounted for more than five hours.

Regarding allegation #3, Staff are not being truthful with Resident’s authorized representative. Information obtained from the reporting party stated that the facility will not give the family a clear answer about Resident’s care. Information obtained from Facility Staff stated it is unclear what this allegation is alleging because the wife of the Resident is the authorized representative and not the Reporting Party.

Pertaining to allegation #4, Staff financially abusing resident. Information obtained from RP stated that on 05/07/20, she received a call from the Resident’s bank that Manager that the Resident and a group of people were at the bank to make a transaction. LPA was not able to contact anyone at the Bank that was aware of the incident and/or the Bank Manager responsible for contacting the RP. Information received from staff interviews stated that the wife is the Resident’s Power of Attorney and she handles the Resident’s finances not the facility.

Based on interviews and documentation reviews the above allegations may have occurred, however is not supported or proved by evidence. Therefore, the allegations are unsubstantiated currently. There was not enough evidence collected to substantiate currently. The preponderance of evidence standard has not been met.

An exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2023

LIC9099 (FAS) - (06/04)

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