336426426-11-5-2021-18-AS-NBRN-C8LPHB-20211109101940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426426
Report Date: 11/05/2021
Date Signed: 11/05/2021 01:42:57 PM

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
02/19/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210219121920

FACILITY NAME:	HOVLEY CARE SERVICES		FACILITY NUMBER:	336426426
ADMINISTRATOR:	CALAMARO, SVETLANA		FACILITY TYPE:	740
ADDRESS:	47-965 VIA NICE		TELEPHONE:	(760) 899-6161
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	6	CENSUS: 0	DATE:	11/05/2021
		UNANNOUNCED	TIME BEGAN:	12:47 PM
MET WITH:	Svetlana Calamaro		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

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On 11/5/21 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 Svetlana Calamaro, explained the purpose of the visit and was granted entry.
Documentation review suggests the facility was providing Resident 1 (R1) with medication as prescribed by their physician. The licensee denied mismanaging R1's medication. The LPA observed the facility kept a Centrally Stored Medication and Destruction Record for R1. The LPA was not able to interview R1 because R1 no longer resides at the facility. The LPA was not able to view R1's medication in person. 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report was provided to Svetlana Calamaro.

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: 11/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2021

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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