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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413159
Report Date: 08/04/2023
Date Signed: 08/04/2023 11:54:54 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
08/03/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230803133419
FACILITY NAME:ANGEL VIEW ADULT DAY CAREFACILITY NUMBER:
336413159
ADMINISTRATOR:MICHELE HUNSAKERFACILITY TYPE:
775
ADDRESS:12379 MIRACLE HILL ROADTELEPHONE:
(760) 329-6471
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:105CENSUS: 0DATE:
08/04/2023
UNANNOUNCEDTIME BEGAN:
10:43 AM
MET WITH:Michelle Hunsaker, AdministratorTIME COMPLETED:
12:03 PM
ALLEGATION(S):
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Staff neglect resulting in injury
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to conduct an investigation into the above allegation. LPA met with Administrator Michelle Hunsaker, and later toured the facility. LPA interviewed Hunsaker, and reviewed and received documents in relation to Client One (C1) and the incident.

It was alleged that Client 1 (C1) slipped out of a Hoyer lift when being transferred to a changing mat. C1's head struck the metal Hoyer lift causing two lacerations over their right eye. C1 did not lose consciousness, bleeding was controlled with direct pressure until emergency services arrived. LPA conducted a review of staff training records.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
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 3
Control Number 18-AS-20230803133419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ANGEL VIEW ADULT DAY CARE
FACILITY NUMBER: 336413159
VISIT DATE: 08/04/2023
NARRATIVE
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Document review indicated that there were 3 involved staff (S1, S2, and S3) within the operation of the sling and transfer of C1 on 07/26/2023. LPA conducted a review of training records related to the safe operation of transfers and utilization of the Hoyer Lift. LPA found that the last training was conducted on 07/03/2023. On that date, S2 was on vacation and S3 was not able to be verified through signature on the training document as being present for the training. Additionally, staff interview revealed that the sling that C1 utilizes is not the one that was utilized when training is conducted by staff. C1's sling was found to be slightly different than others. Staff interview further revealed that when training is conducted, it was done utilizing the more "typical sling". Thus, the allegation was Substantiated.

A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was provided along with copies of the LIC9099-D, and Appeal Rights.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230803133419
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGEL VIEW ADULT DAY CARE
FACILITY NUMBER: 336413159
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2023
Section Cited
CCR
82072(a)(2)
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82072 Personal Rights
(a) Each client shall have personal rights which include, but are not limited to, the following:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs. This requirement was not being met as evidenced by:
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Licensee conducted in-service training with staff on 07/27/23, and on 07/28/23 on safe transfers with several different slings. POC cleared at time of visit.
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Based on staff interview, and record review, LPA found that 2 out of 3 staff members were not present when the last training was conducted for safe transfers of a client. This poses an immediate health and safety and or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3