336423741-12-27-2023-18-AS-JDHS-CYYNCJ-20231229092047

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423741
Report Date: 12/27/2023
Date Signed: 12/27/2023 01:42:08 PM

Unsubstantiated

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
09/19/2023 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20230919083206

FACILITY NAME:	SVS-PALM SPRINGS ADULT DAY PROGRAM		FACILITY NUMBER:	336423741
ADMINISTRATOR:	KENNISHA CAREY		FACILITY TYPE:	775
ADDRESS:	997 E. TAHQUITZ CANYON WAY		TELEPHONE:	(760) 322-6023
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	45	CENSUS: 36	DATE:	12/27/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Program Director, Norshay Easter		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff denied a client from calling an authorized representative
Staff did not address a client's change in medical condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kathleen Banrasavong conducted an unannounced visit to findings for a complaint investigation regarding the above allegations. LPA met with Program Director, Norshay Easter where LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review. LPA was unable to interview Client (C1) or additional witnesses.

On 09/19/2023, Community Care Licensing received a complaint alleging that staff denied a client from calling an authorized representative and staff did not address a client’s change in medical condition. In regards to the allegation that staff denied a client from calling an authorized representative. It was reported that C1 was on at an outing at the Cardenas Supermarket. It was reported that C1 felt sick and wanted to go back to the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20230919083206

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: 12/27/2023

NARRATIVE

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Once C1 returned to the facility, C1 desired to make a phone call, but staff denied. It was also reported that C1’s Responsible Party was not informed of the outing. Information from staff and client interviews stated that the were no issues or concerns regarding clients being able to use the phone or with staff providing responsible parties information regarding outings.

In regards to the allegation that the staff did not address a client’s change in medical condition, it was alleged that the staff did not allow C1 to go back to the facility when C1 felt sick. Information from Lead Staff (S1) stated that S1 called the Program Director, Norshay Easter and Easter instructed S1 to return to the facility with C1. The other clients were in the process of buying and purchasing their lunch and other items. After that was completed, they redirected everyone on the outing to come back to the facility where C1 was dropped off to their responsible party. Program Director stated that they called the responsible party and notified them per facility protocol of the client not feeling well. LPA interviewed additional staff and clients and interviews indicated that there are no concerns or issues regarding authorized representatives being notified of a clients change of condition.

Based on the LPA’s observation, interviews conducted and record review, the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur due to LPA unable to interview C1 and additional witnesses. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report, were discussed with and provided to the Program Director, Norshay Easter.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2023

LIC9099 (FAS) - (06/04)

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