<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336413271
Report Date: 04/06/2022
Date Signed: 04/06/2022 01:36:20 PM


Document Has Been Signed on 04/06/2022 01:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DESERT COTTAGEFACILITY NUMBER:
336413271
ADMINISTRATOR:ELIZABETH HENGSTLERFACILITY TYPE:
740
ADDRESS:83-617 HIMILAYA DRIVETELEPHONE:
(760) 342-7767
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 5DATE:
04/06/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Elizabeth Hengstler - Licensee/AdministratorTIME COMPLETED:
01:45 PM
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
On this date, Licensing Program Analysts (LPAs) Crystal Colvin and Venus Mixon made an unannounced visit to the facility to investigate a complaint #18-AS-20220330113756. During today's inspection, LPA Colvin observed the following deficiency, which was reviewed with Licensee/Administrator Elizabeth Hengstler:

LPA Colvin requested all staff files for those staff who worked at the facility during the month of March 2022. In the stack of staff files presented to LPA Colvin, was staff member (S1), who LPA Colvin observed to not be associated to the facility. LPA Colvin contacted the Riverside Regional Office for Community Care Licensing (CCL) and inquired with staff at the office regarding S1. LPA Colvin discovered that S1 needs an exemption transfer in order to be associated to the facility, and at this time, S1 is only associated to one facility, which is neither of the Licensee's facilities. LPA Colvin reviewed S1's file closely and observed that there was a completed LIC9182 (Criminal Background Clearance Transfer Request) in S1's file, but S1 would need a LIC9188 (Criminal Record Exemption Transfer Request) submitted instead. Additionally, LPA Colvin observed that the ID number on the form in S1's file is incorrect. Since S1 does not have an approved Exemption Transfer to this facility, S1 is not permitted to work, reside, or be present in the facility. Deficiency cited.

Staff present in the facility without proper clearance or exemption transfer results in civil penalties in the amount of $100 per day for a maximum of 5 days. The facility is being cited $500 for the maximum of 5 days, as S1 has been employed and working at the facility since 5/8/20 (according to S1's file).

An exit interview was conducted with Licensee/Administrator Elizabeth Hengstler, and a copy of this report, LIC 809D, LIC421BG, and appeal rights was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 04/06/2022 01:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: DESERT COTTAGE
FACILITY NUMBER: 336413271

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/06/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/07/2022
Section Cited

1
2
3
4
5
6
7
Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (3) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r).... This requirement was not met as evidenced by:
8
9
10
11
12
13
14
Based on record review, the Licensee did not comply with the above regulation with at least one staff member (S1). LPA Colvin observed that S1 has been working at the facility since 2020, but has not requested for their exemption to be transferred. This is an immediate safety risk to all residents in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7

1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 04/06/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/06/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2