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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425954
Report Date: 03/17/2025
Date Signed: 05/15/2025 01:04:32 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/22/2024 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240722120359
FACILITY NAME:CARMIE CARES HOME FOR THE ELDERLY 1FACILITY NUMBER:
336425954
ADMINISTRATOR:JAY SESEFACILITY TYPE:
740
ADDRESS:32220 SHIFTING SANDS TRAILTELEPHONE:
(760) 656-1177
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: 4DATE:
03/17/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Jay Sese, LicenseeTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff are not providing adequate care and supervision for a resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to deliver an amended report to clarify the findings for the above-mentioned allegation. LPA met with Jay Sese, Licensee, and explained the purpose of the visit.

On July 22, 2024, Community Care Licensing received a complaint alleging that staff are not providing adequate care and supervision for a resident. LPA's investigation involved a comprehensive review of Resident #1’s (R1) records and interviews with other residents. The records review included R1’s physician’s report, admission agreement, hospital discharge report, doctor’s order, and medication review report.

During an interview with R1, LPA observed R1 to be slightly confused. R1 was able to demonstrate to LPA how to independently get out of a geriatric chair. Information obtained from R1’s interview revealed R1 never Continues on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
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 2
Control Number 18-AS-20240722120359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: CARMIE CARES HOME FOR THE ELDERLY 1
FACILITY NUMBER: 336425954
VISIT DATE: 03/17/2025
NARRATIVE
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felt they were being confined or isolated.

R1 acknowledged the geriatric chair could prevent them from falling. LPA conducted interview with a witness, and they had no health and safety concerns for R1 living at this facility.

Based on observation, interviews and records review, staff did not provide adequate care and supervision for a resident is Unsubstantiated. A finding of Unsubstantiated means that the allegation may have happened or is valid, but there is no preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted, and a copy of this report was provided to Jay Sese.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2