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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336413159
Report Date: 11/20/2023
Date Signed: 11/20/2023 12:26:23 PM

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
11/13/2023 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231113161114
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: 64DATE:
11/20/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Michelle Hunsaker, AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Staff do not adequately supervise client while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced initial complaint visit to the above noted facility. LPA met with Administrator Michelle Hunsaker and informed them of the purpose of this visit. During this investigation, LPA conducted a tour of the physical plant, conducted interviews with staff, residents, and requested supportive documentation for review.

It was alleged that on 11/8/23, Client #1 (C1) was found outside of the facility sitting in between parked cars with their hands over their ears. It was further reported that staff were aware that C1 was outside, and no one came out to help C1 to come back inside. C1 was reportedly significantly delayed and is known to wander, and potentially could have left the facility or wandered into traffic.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
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-20231113161114
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: 11/20/2023
NARRATIVE
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It was finally reported that this was not the first incident that C1 had been outside without supervision.

Record review indicated that the facility has the responsibility to provide adequate staff to prevent C1 from harming themselves, and from environmental harms by providing meaningful and engaging activities so that C1 may thrive and enjoy a good sense of health and well-being.

Staff interviews indicated that C1 often wanders throughout the facility, and sometimes into the parking lot unsupervised, as C1 is attracted to the "beeping" of the busses. Staff then stated that C1 is difficult to observe as C1 moves quickly throughout the facility, and does not like to be followed. Finally, Staff interviews indicated that C1 has been without staff observation while C1 was outside. This is a violation of regulatory requirements.

Through all of the evidence obtained through staff interviews, as well as record review, this 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 discussed with and provided along with copies of the LIC811, LIC9099D, and Appeal Rights.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20231113161114
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: 11/20/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/04/2023
Section Cited
CCR
80078(a)
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80078 Responsibility for Providing Care and Supervision: (a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not being met as evidenced by:
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Licensee provided in-service training by all staff that was conducted on 11/9/2023 to supervise C1. POC cleared on date of visit.
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Based on staff interview, and record review, C1 has been outside without staff observation, and has been known by staff to lay down near cars, and wander outside. This is a potential 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: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/20/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3