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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423741
Report Date: 11/07/2023
Date Signed: 11/07/2023 09:46:28 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
08/22/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230822085123
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:
11/07/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Program Director, Norshay EasterTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Facility staff failed to provide a safe environment for clients, staff and visitors
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 allegation listed above. LPA met with Program Director, Norshay Easter, and explained the purpose of the visit and the elements of the allegation. LPA Banrasavong conducted the investigation which consisted of observation, interviews with staff members and residents, and record review.
On 08/22/2023, Community Care Licensing received a complaint stating that facility staff failed to provide a safe environment for clients, staff and visitors. It was alleged that two staff members got into a physical altercation at the day program and a resident had to intervene to terminate the fight. The elements of the complaint stated that Staff 1 (S1) and Staff 2 (S2) got into a physical altercation on 08/01/2023. During the investigation, LPA interviewed the Regional Director and the Program Director. Information obtained from the interviews corroborated that the incident occurred. It was also reported that after the incident, the two staff members involved were immediately terminated. LPA interviewed additional staff members who stated they heard yelling and it quickly escalated into a physical altercation. It was advised that staff members terminated the physical altercation and not a resident. Additional interviews revealed that no clients were in the presence of the altercation, but clients were present at the day program. Although the facility took immediate action in terminating the staff members, due to the fact that the incident did occur at the facility, this was an immediate health and safety concern for clients, staff and visitors.
(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-20230822085123
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: 11/07/2023
NARRATIVE
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(Continuation from 9099)

Based on LPA’s 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)(2) 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., are being cited on the attached LIC 9099D.

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.

If no clients were present or in the facility, we would need to cite for conduct inimical. If clients were at the facility and not present, personal rights.

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-20230822085123
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: 11/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/21/2023
Section Cited
HSC
82072(a)(2)
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(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 met, as evidenced by:
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The Program Director, Norshay Easter stated that she will provide proof of training and signed acknowledgment from all staff and send it to the LPA by 11/21/2023 as a plan of correction.
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Based on LPA's record review, interviews, clients were at the facility during the altercation, although not directly in the presence. This is a potential health and safety or personal rights violation.
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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)
Page: 3 of 3