500306146-8-20-2021-27-AS-KHOS-C6FNDZ-20210901102309

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 500306146
Report Date: 08/20/2021
Date Signed: 08/20/2021 02:51:14 PM

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
02/04/2021 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20210204122620

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:	DATE:	08/20/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator Kregg Miller		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident sustained an injury from a fall while in care
Staff did not properly report an incident regarding a resident

INVESTIGATION FINDINGS:

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

On 8/20/2021, Licensing Program Analyst (LPA) Jason Lund arrived at the facility unannounced to complete a complaint investigation regarding the above allegations. LPA Lund meet with Administrator Kregg Miller and explained the reason for the visit.

Based on interviews with staff, witness, and review of records. Resident (R2) did have an unwitnessed fall on 1/26/2021. R2 was sent to the hospital and it was determined that R2 broke R2’s hip. The facility notified Valley Mountain Regional Center Service Coordinator by email and phone call.

It was learned thorough interviews, with staff and witness. R2 doesn’t have a history of falling and this was an isolated incident. R2 has made a full recovery since the fall and is still currently residing at the facility.

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: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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 4

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
02/04/2021 and conducted by Evaluator Jason Lund

COMPLAINT CONTROL NUMBER: 27-AS-20210204122620

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:	DATE:	08/20/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Administrator Kregg Miller		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff is mishandling a resident's personal funds

INVESTIGATION FINDINGS:

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

LPA Lund reviewed resident (R1) records, facility records interviewed staff and witnesses regarding the above allegations.

Based on the investigation through interviews and records, R1 passed away on 1/27/2021. R1 had Personal and Incidental Funds (P&I) at the facility. The family of R1 through Valley Mountain Regional Center requested that R1’s P&I funds get transferred to the family to help pay for funeral arrangements. The facility is in charge of the safeguard of the P&I funds for R1. The facility sent the money back to the payee.

This agency has investigated the complaint allegations. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.
LPA Jason Lund amended the complaint from Unsubstatiated to Unfounded

Exit interview was conducted with Administrator Kregg Miller and a copy of report was left.

Unfounded

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: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20210204122620

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: 08/20/2021

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

Based on interviews with staff, witness and review of records. The facility did email and call R2’s, Valley Mountain Service Coordinator on the day of the incident. The facility recently had staff changes do to a death of a staff member at the facility and was not aware that the facility was supposed to fax in a report to the main line of Valley Mountain Regional within 48 hours until told by the Service Coordinator. The facility faxed in on the third day.

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 Administrator Kregg Miller and a copy of report was left.

SUPERVISOR'S NAME: Stephenie Doub	TELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Jason Lund	TELEPHONE: (916) 223-6752
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4