366423788-7-2-2021-18-AS-JESL-CG8VCN-20220711161925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366423788
Report Date: 07/02/2021
Date Signed: 07/02/2021 12:40:36 PM

Unsubstantiated

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
09/25/2020 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200925153619

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:	12:30 PM
MET WITH:	Administrator Christopher Tanabe		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff stole resident's medications.
Staff did not meet incontinence needs of residents.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) 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 shortly after LPA's arrival. Note that the facility is still temporarily closed. The investigation consisted of a review of pertinent documentation and interviews.

Allegation: Staff stole resident’s medications.
On 10/5/20 LPA conducted an interview with previous Administrator Crystal Green whom did confirm that resident #1 (R1) medication (Hydrocodone-Narcotic) did come up missing. Crystal stated that she does remember seeing the medication sitting on the desk, however the office was being cleaned and there was a bunch of papers and other things that needed to be organized or thrown in the trash. Crystal stated that she

Unsubstantiated

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)

Page: 1 of 2

Control Number 18-AS-20200925153619

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

believes that the medication was tossed in the trash can, however, did not go looking in the dumpster for it to confirm and or to retrieve the medication. LPA interviewed S2 whom denied that they stole the medication. S2 confirmed that yes, they were the one that picked up the medication from the pharmacy and brought it straight back to the facility and placed it on the desk. However they were not able to be located once it came time to do. Administrator Crystal stated that she was going to file a police report but had not done so yet. Based on interviews and record review the allegation of Staff stole resident’s medications is UNSUBSTANTIATED.

Allegation: Staff did not meet incontinence needs of residents.
LPA conducted interviews and inquired about the resident and incontinent care. It was explained that the residents are checked every two hours, and that as needed if the resident were to inform staff that assistance was needed, by using their call button. The facility does not have a log documenting the times that incontinent care had been provided, but it is a known fact that resident’s need to be checked to ensure that their incontinent needs are being met. LPA conducted resident interviews and the feedback provided was that there are not any issues with their incontinent care and that if they have informed staff that they need to be changed, they will be changed as soon as they are finished completing a task, such as tending to another resident is the only time that they have to wait. Therefore, the allegation of Staff did not meet incontinence needs of residents 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.

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 2