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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366404041
Report Date: 06/14/2021
Date Signed: 06/14/2021 03:18:02 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
05/26/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200526092250
FACILITY NAME:SANTA FE TRAIL ASSISTED LIVING CENTERFACILITY NUMBER:
366404041
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: 63DATE:
06/14/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator Michael Garcia TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility is in disrepair.
Staff did not treat resident with dignity or respect.


INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George contacted the facility for the purpose of delivering findings for the above allegation(s). LPA George met with Michael Garcia and advised the purpose of visit. Below is a summary of the findings of the investigation.

The allegations were investigated by the department. Based on a review of information gathered from the facility's history, information from interviews that were conducted and a tour of the facility. Due to faulty electrical wiring the facility had two fires; one on 12/28/19 and the other on 3/9/20. Due to the extent of repairs needed the facility was not able to use the kitchen and had to cater meals. LPA George observed the kitchen covered with plastic and tape, lights and construction tools during the tour on 5/26/20 and 7/22/20. Due to the current pandemic it caused for the original timeline for the completion date to be extended because permits needed to be obtained as well as approved.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 18-AS-20200526092250
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: SANTA FE TRAIL ASSISTED LIVING CENTER
FACILITY NUMBER: 366404041
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/14/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2021
Section Cited
CCR
87468.1
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7
Personal Rights of Residents in all facilities:(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidenced by:
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The administrator will conduct an inservice on confidentiality, and personal rights. The sign in sheet will be submitted to the department by 5pm on the due date indicated.
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Based on observation, interviews and record review, the licensee did not ensure that 1/52 residents were treated with dignity and respect.
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Type B
06/28/2021
Section Cited
CCR
80087(a)
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80087 Buildings and Grounds
(a)The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
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The licensee will have all the necessary indicated repairs fixed. Invoives will be submitted to the department by 5pm on the due date indicated.
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Based on observation, interviews and record review, the licensee did not ensure that there being 2 fires within 3 months of each other, residents being relocated, and the kitchen not be acceesible, as well as multiple leaks throughout the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20200526092250
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: SANTA FE TRAIL ASSISTED LIVING CENTER
FACILITY NUMBER: 366404041
VISIT DATE: 06/14/2021
NARRATIVE
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On 7/21/20 The department received a co-complaint and information provided was that the facility had waste water and sewage spilling out of the building. There was seepage coming up from the ground, running down the hill, and into the street. LPA George spoke with previous Assistant Administrator Jennifer whom admitted that there were leaks in the sinks inside some of the resident bathrooms, that were causing for a back up of the septic tank. An invoice dated 6/30/20 shows the repairs that were needed to the sinks, showers and toilets throughout the facility. Per the invoice from the plumber; the septic tank needed to be pumped on 7/9/20 and 7/12/20. LPA George was able to corroborate the allegation Facility is in disrepair (kitchen, plumbing) is SUBSTANTIATED.

Allegation # 2- Staff did not treat resident with dignity or respect
Based on interviews conducted with S1, and S2, whom confirmed that there was an incident that did occur, that caused for S1 to raise their voice at R1. Due to the fact that S1 admitted that there was a reference made to R1 's ethnicity. LPA George was able to corroborate the allegation. The allegation of Staff did not treat resident with dignity or respect is SUBSTANTIATED. The allegations of a finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.


An exit interview was conducted and a copy of this report, 9099C, and 9099D was provided to Assistant Administrator Jennifer Levesque.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
05/26/2020 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200526092250

FACILITY NAME:SANTA FE TRAIL ASSISTED LIVING CENTERFACILITY NUMBER:
366404041
ADMINISTRATOR:MICHAEL GARCIAFACILITY TYPE:
740
ADDRESS:55425 SANTA FE TRAILTELEPHONE:
(760) 365-0887
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:85CENSUS: 63DATE:
06/14/2021
UNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Administrator Michael Garcia TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George met with Administrator Michael Garcia to also deliver findings for the allegation above. LPA George conducted staff and resident interviews and based on information gathered LPA George was unable to corroborate the allegation. Per previous administrator Jennifer, S1 was spit on by Resident # 1, which caused for S1 to raise their raise voice and walk away from R1. The internal investigation conducted by facility management did not provide enough evidence that the incident did or did not occur.The allegation of Staff handled resident in a rough manner is UNSUBSTANTIATED.

A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 4