336423907-12-3-2021-18-AS-NBRN-C9RP9Y-20211216100754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336423907
Report Date: 12/03/2021
Date Signed: 12/03/2021 10:43:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/14/2020 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20201214155022

FACILITY NAME:	COMFORTS OF HOME RESIDENTIAL CARE, LLC		FACILITY NUMBER:	336423907
ADMINISTRATOR:	CORI COOPER		FACILITY TYPE:	740
ADDRESS:	74-092 JERI LANE		TELEPHONE:	(760) 610-1156
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92211
CAPACITY:	6	CENSUS: 4	DATE:	12/03/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Cori Cooper, licensee/administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff left resident's unattended
Staff is misusing residents' medication for their own personal use
Staff are not administering resident's medication in a timely manner
Staff not meeting resident's needs
Uncleared staff providing care to resident's
Resident's not awarded privacy

INVESTIGATION FINDINGS:

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On 12/3/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of delivering the findings to the above allegations. The LPA met with licensee Cori Cooper, explained the nature of the visit and was granted entry.

The investigation, which consisted of interviews and document review reveald the following:

Staff left residents unattended
The RP stated that they were told by Staff 1 (S1) that on 12/15/20 that the residents were left alone. The licensee denied leaving residents alone. The licensee stated that
S1 quit because the licensee had suspicions of them taking illegal drugs.
***Continued on LIC 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

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-20201214155022

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: COMFORTS OF HOME RESIDENTIAL CARE, LLC	FACILITY NUMBER: 336423907
	VISIT DATE: 12/03/2021

NARRATIVE

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***Continued from 9099***
S1 waited until Staff 2 (S2) came on shift at 3:00PM then S1 left her position for good. Staff 2 (S2) initially stated that the licensee left the resident alone then S2 stated that on 12/15/20 at 2:15PM Staff 1 (S1) gave S2 a report when S2 came onto shift. Information that S2 provided was conflicting.

Staff is misusing residents' medication for their own personal use:
The RP stated that they was told by a few caregivers that some years ago her that the licensee used R1s medication. The licensee denied ever using R1's medication.

Staff are not administering resident's medication in a timely manner:
The RP stated that they did not have any knowledge of the licensee not administering R1's medication or any other resident. The licensee denied not providing resident with their medication in a timely manner. Staff 2 (S2) reported that all staff working at the facility are not qualified. S3 also reported that all staff were provided medication training. S2 provided conflicting information.

Staff not meeting resident's needs:
The RP stated R1's medication was given to R1 at 9:00 AM and 9:00PM. The RP thought that was too late and that the staff should provide the medication at 5:00AM and 5:00PM. The licensee denied not meeting R1's needs. R1's medication was to be given twice a day with no specific time stated. Staff 2 denied staff not meeting the needs of R1.

Uncleared staff providing care to resident's:
The RP stated that she saw Staff 3 (S3) at the facility, but was unsure if S3 was working or not. The licensee denied having uncleared S3 working at the facility. The LPA conducted a confirmation of removal visit for S3 in December of 2020. S3 was not present at the time of the visit. S2 did not have any knowledge of S3 working at the facility.

Resident's not awarded privacy:
The RP denied having knowledge of R1 not having privacy while living at the facility. The licensee denied not providing privacy to R1.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time. An exit interview was conducted where this report and LIC 811 were provided to the licensee.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

LIC9099 (FAS) - (06/04)

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