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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366404072
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:36:22 PM


Document Has Been Signed on 10/30/2023 01:36 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:DESERT ROSE ELDER CAREFACILITY NUMBER:
366404072
ADMINISTRATOR:MCGILL-CUNAGIN, SHARONFACILITY TYPE:
740
ADDRESS:73511 SUNNYVALE DR.TELEPHONE:
(760) 367-9175
CITY:TWENTYNINE PALMSSTATE: CAZIP CODE:
92277
CAPACITY:20CENSUS: 16DATE:
10/30/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Sharon Mcgill-CunaginTIME COMPLETED:
01:35 PM
NARRATIVE
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Licensing Program Analyst (LPA) Magda Malcore conducted a unannounced case management visit to the facility. LPA met with Sharon Mcgill-Cunagin, Administrator, and discussed the purpose of the visit.

On 10/13/23, a staff medication error occurred at the facility. The facility did not report the error to Community Care Licensing until 11 days after the incident (10/24/23).

A deficiency is being cited during today’s visit in accordance with


California Code of Regulations, Title 22, Division 6.

A plan of correction was discussed with Administrator, Mcgill-Cunagin. An exit interview was conducted at the conclusion of the visit and a copies of reports(LIC809/LIC809-D) with appeal rights was provided to the Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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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Document Has Been Signed on 10/30/2023 01:36 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: DESERT ROSE ELDER CARE
FACILITY NUMBER: 366404072

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/03/2023
Section Cited
CCR
87211(a)(1)(D)

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87211(a)Each licensee shall furnish…(1)A written report…to the licensing agency and to the person responsible for the resident within seven days of the occurrence of…(D)Any incident which threatens the welfare, safety or health of any resident..This requirement is not met as evidence by:
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Licensee/Administrator shall submit to the Licensing Agency a statement of understanding on the regulation cited by POC due date.
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A medication error that occurred at the facility on 10/13/23 was not reported to the Licensing Agency until 10/24/23, which poses a potential health, safety or personal rights risk to persons in care.
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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: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda MalcoreTELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
LIC809 (FAS) - (06/04)
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