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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423741
Report Date: 11/06/2023
Date Signed: 11/07/2023 09:59:59 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
09/08/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230908134518
FACILITY NAME:SVS-PALM SPRINGS ADULT DAY PROGRAMFACILITY NUMBER:
336423741
ADMINISTRATOR:KENNISHA CAREYFACILITY TYPE:
775
ADDRESS:997 E. TAHQUITZ CANYON WAYTELEPHONE:
(760) 322-6023
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:45CENSUS: 38DATE:
11/06/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Program Director, Norshay EasterTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff inappropriately enticed resident to participate in unsafe challenge.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegations listed above. LPA met with Program Director, Norshay Easter and explained the purpose of the visit and the elements of the allegations. LPA Banrasavong conducted the investigation which consisted of observation, interviews with staff members and residents, and record review.
On 09/08/2023, Community Care Licensing received a complaint stating that staff inappropriately enticed resident to participate in unsafe challenge.
In regards to the allegation that staff inappropriately enticed resident to participate in unsafe challenge. It was reported that staff enticed residents to play a truth or drinking game. It was alleged that the staff made the residents drink a concoction that was mixed with water, juice, and unknown condiments. During LPA’s interviews, it was confirmed that a truth or drinking game did occur. The game consisted of the clients picking a card and either performing what the card states or drinking in order to receive SVS bucks. SVS bucks are incentives that the facility provides to residents. Resident #1 (R1) stated that they played the truth or drinking game, but it was not forced; voluntarily.
(Continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
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-20230908134518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: SVS-PALM SPRINGS ADULT DAY PROGRAM
FACILITY NUMBER: 336423741
VISIT DATE: 11/06/2023
NARRATIVE
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Continuation from 9099)
Information obtained from the investigation revealed that if the residents did not want to play, they could have opted to be in another group and participate in another activity. Based on LPA’s observation and interview, the C1’s personal rights were violated. From the LPA’s interviews and investigation, it was concluded that the staff at SVS violated C1’s personal rights because staff was not treating C1 with dignity and respect. The game the clients were being enticed to play for SVS bucks violated the client’s ability to be free from unusual ridicule.

Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 Chapter 3, Article 06) 82072 Personal Rights (a)(3) 82072 Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following:) 1 Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning. The Plan of Corrections is to have staff trained on personal rights and a signed letter sent to the LPA as acknowledgement. This Plan of Corrections is due to the LPA by 11/21/2023.

An exit interview was conducted, a copy of this report, appeal rights was provided to the Program Director, Norshay Easter as evidenced by her signature.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230908134518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: SVS-PALM SPRINGS ADULT DAY PROGRAM
FACILITY NUMBER: 336423741
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2023
Section Cited
HSC
82072(a)(3)
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a) Each client shall have personal rights which include, but are not limited to, the following:(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or
other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication, or aids to physical functioning. This requirement was not met as evidenced by:
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The Regional Director, Norshay Easter stated that she will provide training and acknowledgement of staff training and signature to the LPA by 11/21/2023.
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Based on LPA's record review, interviews, R1 was not accorded their personal rights to be free from humiliation, intimidation, ridicule for participating in in "truth or drinking game," that are incentivized. The option for not playing or participating is one that does not allow for the resident to know exactly what they are opting to drink in lieu of the action pulled from the cards.
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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: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 11/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2023
LIC9099 (FAS) - (06/04)
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