361880646-4-28-2021-18-AS-EMAN-C2KKZS-20210430082113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880646
Report Date: 04/16/2021
Date Signed: 04/28/2021 09:15:43 AM

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
08/12/2020 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200812083130

FACILITY NAME:	WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING		FACILITY NUMBER:	361880646
ADMINISTRATOR:	CYNTHIA EDWARDS		FACILITY TYPE:	740
ADDRESS:	11825 APPLE VALLEY ROAD		TELEPHONE:	(760) 961-1212
CITY:	APPLE VALLEY	STATE: CA	ZIP CODE:	92308
CAPACITY:	115	CENSUS: 66	DATE:	04/16/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Monya Henry		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not responding to resident's call button in a timely manner.
Adequate food service is not provided to residents.
Staff are not communicating resident's care needs to the resident's authorized representative.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to deliver findings for the above allegation. LPA contacted the facility via telephone due to the COVID-19 pandemic. LPA spoke with Administrator, Monya Henry, and discussed the purpose of the call. The investigation consisted of interviews and records review.

In regards to allegation #1, LPA interviewed Resident #1 (R1) who stated that it takes anywhere from five to fifteen minutes for a staff member to respond after the call button is pressed. LPA interviewed Resident #2 (R2) and Resident #3 (R3) who stated that they do not use the call button; however, both R2 and R3 recalled previous occasions where they have accidentally pressed the call button and staff members came to assist immediately. LPA interviewed Staff #1 (S1) and Staff #2 (S2) who both stated that the average call button response time is seven minutes. LPA determined there was not enough evidence to meet the preponderance of evidence standard; therefore, the allegation is UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

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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Control Number 18-AS-20200812083130

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 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: WHISPERING WINDS OF APPLE VALLEY ASSISTED LIVING	FACILITY NUMBER: 361880646
	VISIT DATE: 04/16/2021

NARRATIVE

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In regards to allegation #2, LPA interviewed S1, S2, and Staff #3 (S3) who all stated that the facility follows a menu which is reviewed by a registered Dietician. S1 and S2 stated that the facility provides three meals a day plus snacks. Both S1 and S2 stated that food service is always provided in a timely manner. LPA interviewed R1 who stated that at one point the food "wasn't that great' and they had lost weight because they chose not to eat it. R1 stated that as of now, they are currently happy with the food being provided by the facility. R1 stated that the facility provides as much food as a resident requests and the meals are provided on time. LPA interviewed R2 who stated that the food is not the greatest; however, they believe the food is nutritious and meals are provided on time and in adequate portions. R2 stated that they have gained weight and attributed that to the food provided by the facility. LPA interviewed R3 who stated that the food is "better" than previous months and meals are provided on time. R1, R2, and R3 all denied that the facility is providing "snacks" in lieu of a meal. LPA reviewed the facility's food menu in which menu items appeared to be nutritious and in adequate portions for residents. Due to conflicting interviewee statements and lack of evidence to corroborate the allegation, LPA has determined that the allegation is UNSUBSTANTIATED.

In regards to allegation #3, LPA interviewed S3, Staff #4 (S4), and Staff #5 (S5) who all stated that facility protocol is to notify residents authorized representative of changes in conditions, unusual incidents, and re-assessments in a timely manner. S3, S4, and S5, all stated that facility staff follow this protocol. LPA determined there was not enough evidence to meet the preponderance of evidence standard; therefore, the allegation is UNSUBSTANTIATED.

Based on evidence obtained during today’s visit, LPA has determined that the above allegations are UNSUBSTANTIATED; meaning that 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.

An exit interview was conducted where this report (LIC 9099 &LIC 9099C) were discussed and a copy was provided to Henry via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021

LIC9099 (FAS) - (06/04)

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