336410274-6-7-2023-18-AS-EMAN-CT6SEA-20230626134824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410274
Report Date: 06/07/2023
Date Signed: 06/07/2023 01:07:04 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
06/29/2021 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210629113045

FACILITY NAME:	CHRISTMAS COTTAGE		FACILITY NUMBER:	336410274
ADMINISTRATOR:	VICTORIA J. SARSON		FACILITY TYPE:	740
ADDRESS:	320 S. SAN JACINTO ST		TELEPHONE:	(951) 765-1840
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	17	CENSUS: 13	DATE:	06/07/2023
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Kathline Hyland-Manager		TIME COMPLETED:	01:17 PM

ALLEGATION(S):

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Food services are inadequate.
Facility is dirty.
Facility has a bug infestation.
Staff are not meeting the needs of the resident(s).
Failure to give medication according to physician's instructions.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to investigate and delivering findings for the above complaint allegations. LPA met with Manager Kathline Hyland and explained the reason for the visit.

During today’s visit, LPA toured the facility, interviewed staff, interviewed residents, and requested and reviewed facility documents.

For allegation, Food services are inadequate:

During interviews with the residents, the residents stated they were pleased with the meals served at the facility. LPA was informed that the residents are served three (3) meals a day and three (3) snacks throughout the day. Residents stated that if they were hungry outside of the scheduled mealtimes and scheduled snack times that the facility offered additional food.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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 4

Control Number 18-AS-20210629113045

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: 336410274
	VISIT DATE: 06/07/2023

NARRATIVE

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The meals served at the facility have a mixture of vegetables, fruit, protein, and carbohydrates.

During interviews with the staff, the staff stated that the residents are served three (3) meals a day and three (3) snacks a day. If a resident requests food outside of the scheduled mealtimes and snack times, staff will provide additional food choices. The meals served at the facility have a mixture of vegetables, fruit, protein, and carbohydrates.

During document review, LPA reviewed the facilities weekly meal menus. The facility menu shows that the residents are served a mixture of vegetables, fruit, protein, and carbohydrates.

For allegation, Facility is dirty:

During interviews with the residents, the residents stated that their bedrooms are cleaned daily by care staff and by housekeeping staff. The residents did not have any concerns about the cleanliness of their bedrooms or the main areas of the facility.

During interviews with staff, the staff stated that the resident’s bedrooms are deep cleaned by housekeeping staff every other day. The resident’s bedrooms are spot cleaned by care staff every day. The main areas of the facility are cleaned daily by housekeeping staff. The kitchen is deep cleaned daily, as well as after each mealtime. The NOC shift has a schedule of rotating areas that are cleaned nightly throughout the facility.

During document review, LPA reviewed the NOC shift cleaning duty document. The cleaning duty document lists the day of the week and the area of the facility that is cleaned nightly.

For allegation, Facility has a bug infestation:

During interviews with residents, the resident’s stated that they have not seen bugs in their bedroom’s, and they have not seen bugs in the main areas of the facility.

During interviews with staff, the staff stated that they have not seen bugs in the resident’s bedrooms, and they have not seen bugs in the main areas of the facility. The staff stated that the facility has the company Orkin complete a monthly pest service to ensure the facility is free of bugs.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 18-AS-20210629113045

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: 336410274
	VISIT DATE: 06/07/2023

NARRATIVE

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During document review, LPA reviewed an Orkin pest statement for May 2023 and June 2023. The statement shows that Orkin completes a monthly pest treatment for the facility.

During facility tour, LPA did not see any bugs in the resident’s bedrooms and or in the main areas of the facility.

For allegation, Staff are not meeting the needs of the resident(s):

During interviews with residents, the residents stated that they were pleased with the amount of care that is provided by the care staff. The residents stated that the care staff checks on them very often. The residents stated that they have a call button that they use in-between staff room checks. When they push their call button, staff comes to their room quickly. The residents did not have any complaints about the care provided to them by the staff.

During interviews with staff, the staff denied that they are not meeting the residents needs. The staff stated that they check on the residents every fifteen (15) to twenty (20) minutes. If a resident pushes their call button, staff responds to the call within five (5) to ten (10) minutes.

For allegation, Failure to give medication according to physician's instructions:

During interviews with residents, the residents did not have any complaints about staff giving them their medication. The residents were not aware of any instances of medications being spilt. The residents were not aware of any instances where medication was being given to them while they were asleep.

During interviews with staff, the staff denied not following the resident’s physician's orders. The staff was not aware of any instances where medication was split or given to the residents while they were sleeping.

Based on the evidence found during the investigation, the five (5) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 18-AS-20210629113045

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: 336410274
	VISIT DATE: 06/07/2023

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32	During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and provided to Manager Kathline Hyland, along with a copy of the appeal rights.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Ryan Gardner	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4