336426505-5-17-2024-18-AS-JDHS-D5RS2J-20240530132935

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426505
Report Date: 05/17/2024
Date Signed: 05/17/2024 10:08:20 AM

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
12/07/2020 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20201207165056

FACILITY NAME:	STONEWALL GARDENS ASSISTED LIVING		FACILITY NUMBER:	336426505
ADMINISTRATOR:	BOEDDEKER, ALLEN		FACILITY TYPE:	740
ADDRESS:	2150 N PALM CANYON DR		TELEPHONE:	(760) 548-0970
CITY:	PALM SPRINGS	STATE: CA	ZIP CODE:	92262
CAPACITY:	35	CENSUS: 22	DATE:	05/17/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Marketing and Resident Enrichment Director, Brian Trout		TIME COMPLETED:	10:25 AM

ALLEGATION(S):

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Staff not supervising resident resulting in multiple falls
Resident’s money was stolen

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Marketing and Resident Enrichment Director, Brian Trout, where LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review.

On 12/07/2020, Community Care Licensing received a complaint alleging that Staff did not supervise resident resulting in multiple falls and Resident’s money was stolen. It was reported that R1 was being hospitalized due to multiple falls and that staff members were not supervising the resident. Information obtained from an interview with Administrator, Chad Boeddeker stated R1 would sustain bruises occasionally due to being a fall risk. Administrator reported R1 would not request staff assistance when ambulating. Information obtained from interviews with additional staff members indicted there were no issues with assisting the residents during this time period. Interviews with residents corroborated that they were able to get assistance if requested. After reviewing R1’s records, he was indicted to be a fall risk and had regular 30 minutes intervals room checks. LPA was unable to interview R1 due to the resident passing away in March 2021. LPA also attempted to interview R1’s responsible party, but LPA was unable to obtain contact.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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-20201207165056

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: STONEWALL GARDENS ASSISTED LIVING	FACILITY NUMBER: 336426505
	VISIT DATE: 05/17/2024

NARRATIVE

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In regards to the allegation of Resident’s money was stolen, it was alleged that the facility did not safeguard R1’s money. The Marketing and Resident Enrichment Director, Brian Trout stated that they have a safeguarding form that the client’s fill out prior to become residents at the facility. If any theft or loss occurs, the policy is to notify the police if the value is over $25.00. Information obtained from an interview with Staff Member stated that they overheard R1 mention they had lost their wallet; however, the staff member could not recall specific details pertaining to the incident. Additional interviews could not provide any information to corroborate or refute the allegation. Therefore, due LPA unable to obtain information from pertinent parties, this allegation is deemed unsubstantiated at this time.

Based on the LPA’s observation, interviews, and record review, the allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report, were discussed with and provided to the Marketing and Resident Enrichment Director, Brian Trout.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC9099 (FAS) - (06/04)

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