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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426550
Report Date: 10/26/2022
Date Signed: 10/26/2022 12:37:51 PM


Document Has Been Signed on 10/26/2022 12:37 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DESERT COVE ASSISTED LIVING AT DESERT HOT SPRINGSFACILITY NUMBER:
336426550
ADMINISTRATOR:HEATHER SCOTTFACILITY TYPE:
740
ADDRESS:13660 MOUNTAIN VIEW ROADTELEPHONE:
(760) 671-7820
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:56CENSUS: 47DATE:
10/26/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Liliana Valenzuela, Medical TechnicianTIME COMPLETED:
12:48 PM
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to conduct a case management visit to follow up on information that was reported to the Department regarding a resident death. LPA met with Medical Technician Liliana Valenzuela, and explained the purpose of today's visit, and toured the facility. Administrator Heather Scott arrived during the visit.

The visit is in response to the death of Resident #1 (R1), who passed away approximately on 10/17/2022 at an undetermined time.

During LPA's visit, LPA reviewed R1's file and obtained copies of the following: ID/emergency Information, Physician's reports, resident appraisal, medication records (MARs) for the month of 10/2022, and Hospice records. LPA also requested a copy of R1s death certificate when it is made available.

During today's visit, no deficiencies were cited in regard to this incident.

An exit interview was conducted, and a copy of this report was provided to Administrator Heather Scott.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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