336426505-9-15-2020-18-AS-NBRN-BTGVG4-20200915162455

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426505
Report Date: 03/09/2020
Date Signed: 09/15/2020 02:11:51 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 MS29-26
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/06/2019 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20190806091103

FACILITY NAME:	STONEWALL GARDENS ASSISTED LIVING		FACILITY NUMBER:	336426505
ADMINISTRATOR:	JOHNSON, SHANNON		FACILITY TYPE:	740
ADDRESS:	2150 N PALM CANYON DR		TELEPHONE:	(760) 548-0970
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	35	CENSUS: 21	DATE:	03/09/2020
		UNANNOUNCED	TIME BEGAN:	03:45 PM
MET WITH:	Executive Director Chad Boeddeker		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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1) Staff failed to administer medication as prescribed.
2) Facility failed to issue refund.
3) Facility charged for additional services without notice.

INVESTIGATION FINDINGS:

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On 3/9/20 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of delivering the findings to the above allegations. LPA met with Executive Director (ED) Chad Boeddeker, explained the nature of the visit and was granted entry.

The investigation consisted of interviews and file reviews revealed the following:
Allegation #1- Staff failed to administer medication as prescribed:
R1's assessment and pre-appraisal where completed on 5/27/19. Medication orders were placed on 5/29/19 and R1 moved in on 5/30/19. The medication order was approved after 5/31/19. The facility monitored R1's blood pressure on 5/3019, 5/31/19, 6/1/19, 6/4/19 R1's. All blood pressure readings were ideal. The facility staff did not administer the medication until it was approved, therefore the allegation that staff failed to administer medication as prescribed is unsubstantiated.
***continued on 9099C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

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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Control Number 18-AS-20190806091103

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-26
RIVERSIDE, CA 92507

FACILITY NAME: STONEWALL GARDENS ASSISTED LIVING	FACILITY NUMBER: 336426505
	VISIT DATE: 03/09/2020

NARRATIVE

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***continued from 9099***

Allegation #2 Facility failed to issue a refund:
R1's move in date was 5/30/19 and a $1,500 community fee was charged. R1's move out day was 8/9/19. According to the Community Fee Refund policy, at the third month, 40% of $1,500 is $600. On 7/9/19 and 11/20/19, the ED issued past due notices for an unpaid balance for R1 in the amount of $1,052.25, therefore R1 is not due a refund. The allegation that facility staff failed to issue a refund is unsubstantiated.

Allegation #3- Facility charged for additional service without notice:
On 5/20/19 the Needs and Service plan meeting was held. The ED, a Registered Nurse, R1 and R1's Power of Attorney (POA) were in attendance. The plan indicated all total assists. R1's physician report dated 1/25/19 was faxed to the facility on 5/30/19. The report indicates that R1 requires a one person total assist, however it was missing R1's weight. After R1 was admitted to the facility, the staff discovered that a 2 person assist was needed instead of a one person assist. The "Fee Increase" section of the admission agreement indicates that if there is a change in the resident's condition, the resident's individual care fee may change. Notice of such change to the residents monthly care fee due to the resident's changed physical care needs will be provided to the resident and/or responsible party within two (2) business days of the new care fee implementation. The ED notified R1's POA of the fee increase within the allotted time frame. The allegation that the facility charged for additional service without notice is unsubstantiated.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report was discussed with and provided to the ED.

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020

LIC9099 (FAS) - (06/04)

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