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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 10/19/2023
Date Signed: 10/19/2023 12:38:59 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
10/12/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231012144558
FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:66CENSUS: 48DATE:
10/19/2023
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Maria Arriaga, Executive Director TIME COMPLETED:
12:50 PM
ALLEGATION(S):
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Facility staff did not assist resident with meals as needed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation noted above. LPA met with Maria Arriaga, Executive Director and explained the purpose of the visit and the elements of the allegation. The allegation was investigated, the investigation consisted of observations, interviews and a review of records.

It was alleged that facility staff did not assist resident with meals as needed. On or around 06/20/23, Resident #1 (R1) sustained an injury while at the facility. Per a review of the facility's progress notes, R1 would not eat at times due to reporting being and observed to be in pain or not feeling well. An additional assessment dated 06/26/23 conducted by facility staff notes R1 to need/receive standby assistance and monitoring due to resistance eating or swallowing difficulties. Prior to the injury, R1 would normally eat their meals in the back dining room, which has increased supervision and staff provided cuing. After the sustained injury R1 is noted to refuse to get up for meals, the facility staff would then bring a food tray to R1s room. Per the Executive Director no reports had been received that staff did not provide any residents with
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
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 2
Control Number 18-AS-20231012144558
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 10/19/2023
NARRATIVE
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with feeding as indicated or needed. Per interviews with multiple facility staff revealed corroborated what was documented in R1s progress notes. Which was R1 would eat some days, and would not eat others, but the attempts were made. There is insufficient evidence to corroborate or refute the allegation of facility staff did not assist resident with meals as needed, therefore the allegation is UNSUBSTANTIATED at this time. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted, a copy of this report was reviewed and provided along with the 9099C, and appeal rights were given to Executive Director Maria Arriaga.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2