500306146-12-22-2022-27-AS-SRIN-CPJ4DC-20230301180029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500306146
Report Date: 12/22/2022
Date Signed: 12/22/2022 03:26:34 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220817104026

FACILITY NAME:	LAS PALMAS ESTATES		FACILITY NUMBER:	500306146
ADMINISTRATOR:	MILLER, KREGG		FACILITY TYPE:	740
ADDRESS:	1617 COLORADO		TELEPHONE:	(209) 632-8841
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	89	CENSUS: 85	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Le Ann Blocker Resident Coordinator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident's closet door is in disrepair

INVESTIGATION FINDINGS:

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On 12/22/2021, Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to complete a complaint investigation regarding the above allegations. LPA Lund meet with Le Ann Blocker Resident Coordinator and explained the reason for the visit.
Resident's closet door is in disrepair-LPA Lund reviewed facility records interviewed staff and witnesses regarding the above allegation.
On 8/19/2022 LPA Lund and Resident Coordinator Le Ann Blocker observed Resident’s (R1) room closet off the hinges and fallen into the closet of R1. R1 has since moved rooms so maintenance can do repairs to the room.
As a result of this investigation, this LPA found the allegations to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

Substantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

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 5

Control Number 27-AS-20220817104026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/22/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/05/2023 Section Cited CCR 80087(a)	1 2 3 4 5 6 7	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	1 2 3 4 5 6 7	Administrator is fixing the room.
	8 9 10 11 12 13 14	Based on observation the Residents closet door was in disrepair. This poses a potential health risk to the persons in care	8 9 10 11 12 13 14
	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: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/17/2022 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20220817104026

FACILITY NAME:	LAS PALMAS ESTATES		FACILITY NUMBER:	500306146
ADMINISTRATOR:	MILLER, KREGG		FACILITY TYPE:	740
ADDRESS:	1617 COLORADO		TELEPHONE:	(209) 632-8841
CITY:	TURLOCK	STATE: CA	ZIP CODE:	95382
CAPACITY:	89	CENSUS: 85	DATE:	12/22/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Le Ann Blocker Resident Coordinator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not notify responsible party of resident's change of health condition

Staff do not serve nutritious meals

Staff hide resident's personal belongings

Facility is not taking preventative measures to address roaches

INVESTIGATION FINDINGS:

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Staff did not notify responsible party of resident's change of health condition- LPA Lund reviewed facility records interviewed staff and witnesses. Resident’s (R1) Valley Mountain Individual Plan dated 6/14/2022. R1 requires assistance monitoring R1 medical needs. The facility Primary Care Physician (PCP) and Nurse Practitioner (NP) have routine visits with R1 for check-ups and medication reviews. Valley Mountain Regional Center Quarterly Progress Review dated 10/6/2022 states that R1 is being monitored by the facility primary care physician and has had some swelling and wears pressure hoses to assist with the swelling.

Based records review and interviews with staff on the information provided, it was unclear if staff did not notify responsible party of resident's change of health condition therefore the allegation was deemed UNSUBSTANTATED.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 27-AS-20220817104026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
	VISIT DATE: 12/22/2022

NARRATIVE

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Staff do not serve nutritious meals- LPA Lund reviewed facility, resident (R1) records and interviewed staff. R1’s LIC 602 dated 8/30/2022 states that R1 is on a diabetic diet.

Las Palmas Estates menu for November Menu Addendum states- The menu attached is the items for the general population. The desserts are various items: Chocolate and white cakes, puddings, jello, ice cream, cupcakes and pastries.
The menu adjustments for diabetics that have doctor orders to adjust the diet are:
The menu is the same with smaller portions of starches and proteins. Higher portions of salad and vegetables.
The desserts are various sugar free desserts,
The residents are limited on receiving seconds or additional servings.

LPA Lund observed lunch from residents in care and looked to have the correct portions for residents in care. LPA Lund interviewed head chief and he had the proper credentials to prepare meals the residents in care.

Based records review, interviews with staff and observations on the information provided, it was unclear staff do not serve nutritious meals if therefore the allegation was deemed UNSUBSTANTIATED.

Staff hide resident's personal belongings- LPA Lund interviewed staff and clients. LPA Lund observed many different dolls on Resident’s (R1) bed and didn’t observe any dolls anywhere else. LPA Lund interviewed staff and clients and stated that never seen staff hide R1 belongs. Interviewing staff stated that R1’s old roommate would hide some of R1’s dolls and has since been moved in with a new roommate.

Based on interviews with staff, clients and observation on the information provided, it was unclear if staff hide resident's personal belongings therefore the allegation was deemed UNSUBSTANTIATED.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 27-AS-20220817104026

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: LAS PALMAS ESTATES	FACILITY NUMBER: 500306146
	VISIT DATE: 12/22/2022

NARRATIVE

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Facility is not taking preventative measures to address roaches- LPA Lund reviewed facility records, interviewed staff and residents in care. LPA Lund reviewed the Clark Pest Control facility service history from 12/01/2021 through 11/17/2022 stating the facility has pest control service at the facility.

Based on facility records review, clients and staff interviews on the information provided, it was unclear if facility is not taking preventative measures to address roaches therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
Exit interview was conducted with Le Ann Blocker Resident Coordinator and a copy of report was left along with a copy of the appeal rights.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5