366423788-7-2-2021-18-AS-JESL-CG8VDK-20220711162052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423788
Report Date: 07/02/2021
Date Signed: 07/02/2021 12:48:28 PM

Substantiated

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
08/28/2020 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200828160829

FACILITY NAME:	AASPEN VILLAGECARE		FACILITY NUMBER:	366423788
ADMINISTRATOR:	MUSHTAQ KHAN		FACILITY TYPE:	740
ADDRESS:	7633 KICKAPOO TRAIL		TELEPHONE:	(760) 365-8300
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY:	15	CENSUS: 0	DATE:	07/02/2021
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Administrator Christopher Tanabe		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility air conditioning is not working.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation listed above. LPA George identified herself and discussed the purpose of the visit and the elements of the allegation(s) with LPA was greeted and granted entry by Caregiver Cassandra Loe. Administrator Christopher Tanabe arrived a few minutes after LPA's arrival. Note that the facility is still temporarily closed. The investigation consisted of a review of pertinent documentation and interviews.

Based on observation and interviews LPA was able to corroborate the allegation. LPA interviewed Administrator Tammy Barnett whom stated that “yes the air conditioner was broken”. During the virtual tour conducted on 8/31/20, LPA observed staff fanning themselves with paper due to the air conditioner being broken in the office. In the resident bedrooms. LPA observed standing/floor fans being used as many as to 2 per room. Tammy explained that the electrician had come out on 8/28/20 and stated that he

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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-20200828160829

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: AASPEN VILLAGECARE	FACILITY NUMBER: 366423788
	VISIT DATE: 07/02/2021

NARRATIVE

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needed to order additional parts because the back panel needed to be replaced, after changing all of the vents, the air conditioner has been working inconsistently off and on for about a month or so. Due to the air conditioner malfunctioning, 5 residents were moved rooms. The allegation of Facility air conditioning is not working is SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. This poses an immediate health and safety risk to persons in care.

An exit interview was conducted and a copy of this report and appeal rights was provided to Administrator Christopher Tanabe.

SUPERVISOR'S NAME: Joel Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20200828160829

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: AASPEN VILLAGECARE	FACILITY NUMBER: 366423788
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/02/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 07/03/2021 Section Cited CCR 87303(b)(1)	1 2 3 4 5 6 7	87303 (b) (1) Maintenance and Operation (b) A comfortable temperature for residents shall be maintained at all times. (2) The facility shall cool rooms to a comfortable range, between 78 degrees F (26 degrees C) and 85 degrees F (30 degrees C), or in areas of extreme heat to 30 degrees F less than the outside temperature. Based on observation, interview and record review this requirement is not met as evidenced by: 1 out of 1 times the facility was not at a comfortable temperature. This poses a potential health and safety risk to persons in care.	1 2 3 4 5 6 7	The licensee agrees to have the air conditioner repaired and submit the invoices to the department by 5pm on the due date indicated.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Esquivel	TELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC9099 (FAS) - (06/04)

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