336426054-6-18-2021-18-AS-NBRN-C47PBR-20210621111045

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 06/17/2021
Date Signed: 06/18/2021 08:03:48 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
06/15/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210615134643

FACILITY NAME:	CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER		FACILITY NUMBER:	336426054
ADMINISTRATOR:	WILKIN, RONDA		FACILITY TYPE:	740
ADDRESS:	47805 CALEO BAY DRIVE		TELEPHONE:	(760) 771-6100
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	66	CENSUS: 61	DATE:	06/17/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Heather Myers, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not allow resident to have visitors
Facility staff did not report an out break as required

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 6/17/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of investigating the above allegations. The LPA met with Executive Director, Heather Myers Richard Mariona House Services Director/LVN, explained the nature of the visit and was granted entry.

The facility did not allow visitation because there was an outbreak of an unknown source at the facility on or around 3/11/21. The facility took the proper precautionary measures to help mitigate the spread of the outbreak to residents, staff and visitors by not allowing visitors into the facility, therefore this allegation is UNFOUNDED. The facility reported the outbreak to Community Care Licensing, the residents, responsible parties of the residents and posted notices throughout the facility, therefore the allegation of the not reporting the outbreak is UNFOUNDED. This agency has investigated the complaint allegations. We have found that the complaint was unfounded meaning that the allegations are false, could not have happened and/or are without a reasonable basis. An exit interview was conducted where this report was discussed with and provided to the executive director.

Unfounded

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: 06/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2021

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 1