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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425566
Report Date: 08/20/2021
Date Signed: 08/20/2021 03:48:22 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
08/18/2021 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210818093958
FACILITY NAME:HOVLEY CARE LLCFACILITY NUMBER:
336425566
ADMINISTRATOR:SVETLANA CALAMAROFACILITY TYPE:
740
ADDRESS:40827 HOVLEY COURTTELEPHONE:
(760) 568-4100
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 4DATE:
08/20/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carmita Smith - CaregiverTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is in disrepair

Fire detectors are in disrepair
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation for a complaint with the above allegation(s). LPA Colvin was granted entrance and met with caregiver Carmita Smith, who assisted LPA Colvin during today's inspection. Administrator Svetlana Calamaro was not able to be present during today's inspection but was contacted via telephone and informed of the purpose of today's visit. Below is a summary of today's findings:

Regarding allegation "Facility is in disrepair": LPA Colvin inspected various appliances and interviewed staff and Administrator Calamaro regarding the allegation. LPA Colvin observed that the kitchen microwave was only partially operational, as the "start" button was not working, so staff must press "micro express" which starts the cooking process with 30 seconds of cook time. Due to this, caregivers must press the "micro express" button multiple times or in succession after each cooking period. LPA Colvin additionally observed that the pipes below the kitchen sink are leaking, as evidenced by buckets/containers filled with water placed underneath the sink.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
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 6
Control Number 18-AS-20210818093958
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: HOVLEY CARE LLC
FACILITY NUMBER: 336425566
VISIT DATE: 08/20/2021
NARRATIVE
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The Administrator stated that they had a meeting with the landlord the previous day and is working on getting items fixed or replaced, including the garbage disposal. Based on observations and interviews, the allegation "Facility is in disrepair" is SUBSTANTIATED.

Regarding allegation "Fire detectors are in disrepair": LPA Colvin toured the facility and tested all smoke detectors in common areas and resident bedrooms. LPA Colvin observed that all smoke detectors tested were operational except for the smoke detector in the hallway separating the two resident bedrooms on the right-hand side of the facility. When LPA Colvin tested this smoke detector, LPA Colvin hear a quiet beep, but did not observe the expected loud noise which would alert occupants to a potential fire. LPA Colvin spoke on the phone with the Administrator, who confirmed that they had heard the same small beep the previous day when they tested the alarms, as some of the smoke alarms had just been replaced. Additionally, whiel LPA Colvin was typing this report, LPA Colvin could hear the occasional beeping that LPA Colvin identified as coming from the direction of the non-operable smoke detector. This beeping is commonly observed when a smoke detector has low batteries. Therefore, based on observations and interviews, the allegation "Fire detectors are in disrepair" is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

Fire clearance and fire safety deficiencies are categorized in Title 22 Regulations and Health and Safety Code as immediate hazards which result in an immediate civil penalty in the amount of $500. Therefore, based on the inoperable smoke detector, LPA Colvin is citing a one time $500 civil penalty.

An exit interview was conducted where this report and appeal rights were discussed. A copy of this report, LIC9099D, LIC401IM, and appeal rights was provided to caregiver Carmita Smith during the exit interview. All reports additionally will be emailed to the Administrator as well.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20210818093958
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: HOVLEY CARE LLC
FACILITY NUMBER: 336425566
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/20/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/23/2021
Section Cited
CCR
1569.49(c)(2)(A)
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Civil penalties...for deficiencies: (c) The department shall assess an immediate civil penalty of five hundred dollars ($500)...for any of the following serious violations: (2) (A) Fire clearance violations, including, but not limited to...inoperable smoke alarms... This requirement was not met as evidenced by:
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Licensee agrees to have the smoke detector fixed, replaced, or have the batteries changed, whichever is required to make it operational. Licensee may self-certify to LPA Colvin that the smoke detector is operational. Self-certification due to LPA Colvun by 8/23/21.
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Based on observations and interviews, the Licensee did not comply with the above regulation with 1 of 6 smoke detectors. LPA Colvin observed the smoke detector in the hallway in-between the resident bedrooms on the right of the facility to be inoperable. This is an immediate safety hazard for all residents.
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Type B
08/31/2021
Section Cited
CCR
87303(a)
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Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by:
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Licensee agrees to have the microwave and kitchen sink pipes either repaired or replaced. Licensee may self-certify to LPA Colvin that the appliances/fixtures have been corrected. Self-certification due to LPA Colvun by 8/31/21.
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Based on observation and interviews, the Licensee did not comply with the above regulation with two facility appliances/fixtures. LPA Colvin observed the kitchen microwave and kitchen sink to be in disrepair (start button on microwave and leaking sink pipes). This is a potential personal rights violation.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
08/18/2021 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210818093958

FACILITY NAME:HOVLEY CARE LLCFACILITY NUMBER:
336425566
ADMINISTRATOR:SVETLANA CALAMAROFACILITY TYPE:
740
ADDRESS:40827 HOVLEY COURTTELEPHONE:
(760) 568-4100
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:6CENSUS: 4DATE:
08/20/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carmita Smith - CaregiverTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Facility premises are not properly secured

Facility does not have a carbon monoxide detector
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation for a complaint with the above allegation(s). LPA Colvin was granted entrance and met with caregiver Carmita Smith, who assisted LPA Colvin during today's inspection. Administrator Svetlana Calamaro was not able to be present during today's inspection but was contacted via telephone and informed of the purpose of today's visit. Below is a summary of today's findings:

Regarding allegation "Facility premises are not properly secured": LPA Colvin toured the facility and observed the area of concern (pool) to be secured from Dememtia residents with a small padlock on the latch of the gate surrounding the pool. LPA Colvin observed the key to the lock on the pillar near the gate, but the key is approxiamtely six feet high and the majority of the facility's residents are bed-bound or non-ambulatory. LPA Colvin observed that the facility does have one resident that walks about the facility on his own, so LPA Colvin suggested to caregiver Carmita to move the key to somewhere more secured. Therefore, based on observations, the allegation "Facility premises are not properly secured" is UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20210818093958
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: HOVLEY CARE LLC
FACILITY NUMBER: 336425566
VISIT DATE: 08/20/2021
NARRATIVE
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Regarding allegation "Facility does not have a carbon monoxide detector": LPA Colvin toured the facility and did not observe any individual carbon monoxide detectors in the facility. LPA Colvin interviewed the Administrator who informed LPA Colvin that the newly purchased/installed smoke detectors have carbon monoxide detectors in them as well. LPA Colvin confirmed seeing the new smoke alarms, and LPA Colvin has the knowledge from inspecting facilities that the new smoke detectors come with carbon monoxide detectors incorporated in them. Therefore, based on observations and interviews, the allegation "Facility does not have a carbon monoxide detector" is UNFOUNDED.

his agency has investigated the complaint alleging facility premises are not properly secured and facility does not have a carbon monoxide detector. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted where this report was discussed. A copy of all reports and forms were provided to caregiver Carmita Smith during the exit interview. All reports additionally will be emailed to the Administrator as well.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6