336426470-3-10-2021-18-AS-RLAY-BYZULB-20210311144024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426470
Report Date: 03/10/2021
Date Signed: 03/10/2021 01:55:47 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
08/28/2020 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200828125103

FACILITY NAME:	ATTENTIVE MANOR		FACILITY NUMBER:	336426470
ADMINISTRATOR:	MATTHEW SIEGEL		FACILITY TYPE:	740
ADDRESS:	66-338 FOURTH ST.		TELEPHONE:	(760) 251-4330
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY:	6	CENSUS: 0	DATE:	03/10/2021
		UNANNOUNCED	TIME BEGAN:	01:43 PM
MET WITH:	Matthew Siegel, Administrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Residents are being mistreated while in care
Resident sustained unexplained injuries while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tricia Danielson contacted the facility via telephone to conclude a complaint investigation into the allegations listed above. LPA identified herself and discussed the purpose of the call and the elements of the investigation with Administrator (AD) Matthew Siegel. Regarding the allegation "residents are being mistreated while in care", it was alleged that Staff #1 (S1) verbally abused and did not properly monitor the residents in care. Two (2) of two (2) witnesses interviewed and one (1) of one (1) staff interviewed reported no issues with S1 in how S1 monitored or treated the residents. S1 denied ever mistreating residents. LPA was unable to interview facility residents due to cognitive impairments. Regarding the allegation "resident sustained unexplained injuries while in care", it was alleged that Resident #1 (R1) suffered a bruise to the wrist/forearm area as a result of an unknown manner. Records reviewed indicated an incident occurred in which R1 became angry, attempted to leave the dining room table and lost their balance. S1 was able to grab R1 by the right arm and ease R1 to the floor before falling. R1 suffered a bruise as a result therefore the injury was not unexplained. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided via email along with LIC 811- Confidential Names list.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Reyna Lacey	TELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 03/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2021

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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