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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423672
Report Date: 04/25/2023
Date Signed: 04/25/2023 11:01:40 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/14/2021 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210114142518
FACILITY NAME:DESERT COTTAGE IIFACILITY NUMBER:
336423672
ADMINISTRATOR:ELIZABETH HENGSTLERFACILITY TYPE:
740
ADDRESS:83-421 MATADOR COURTTELEPHONE:
(760) 289-6287
CITY:INDIOSTATE: CAZIP CODE:
92203
CAPACITY:6CENSUS: 4DATE:
04/25/2023
UNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Elizabeth Hengstler, Licensee/AdministratorTIME COMPLETED:
11:07 AM
ALLEGATION(S):
1
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9
Staff is administering medication to resident without a prescription.
Staff are not wearing face masks.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with Licensee/Administrator Elizabeth Henstler and explained the purpose of the visit. This allegation was investigated by department staff.

Allegation # 1 “Staff is administering medication to resident without a prescription”. The allegation alleged that the facility’s staff members administered over-the-counter medication to resident #1 (R1) without a prescription. Department staff interview staff # 1 (S1) revealed that S1 denied administering medication to R1 without a physician’s order. S1 stated that they had not observed another member of the facility’s staff administering medication to R1 without a physician’s order. S1 also stated that the Licensee/Administrator has never directed them to administer medication to R1 without a physician’s order. Department interview with staff # 2 (S2) revealed that they denied administering medication to R1 without a physician’s order. S2 stated that they had not observed another member of the facility’s staff administering medication to R1 without a physician’s order. S2 also stated that the Licensee/Administrator has never directed them to administer medication to R1 without a physician’s order.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
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-20210114142518
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: DESERT COTTAGE II
FACILITY NUMBER: 336423672
VISIT DATE: 04/25/2023
NARRATIVE
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Department staff interview with the Licensee/Administrator revealed that the hospice physician prescribes all medication and over-the-counter medication administered to R1. Department staff file review revealed that R1 was prescribed over-the-counter medication by their physician. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation # 2 “Staff are not wearing face masks”. The allegation also alleged that the facility’s staff members are not wearing face masks. Department staff interview with S1 revealed that the facility supplies all staff with the necessary personal protective equipment (PPE), which includes N-95 masks, disposable masks, gloves, hand sanitizer, hand soap gowns, and face shields. S1 stated that they always wear a mask while working at the facility. Department staff interview with S2 revealed that the facility supplies all staff with the necessary PPE, which includes N-95 masks, disposable masks, gloves, hand sanitizer, hand soap gowns, and face shields. S2 stated that they always wear a mask while working at the facility. Department staff interview with the Licensee/ Administrator stated that facility staff members must wear masks. The Licensee/Administrated stated that PPE is available at the facility for staff. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

A finding of 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.

An exit interview was conducted and copy of this report provided.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2