<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336425566
Report Date: 08/20/2021
Date Signed: 08/20/2021 03:50:07 PM

Document Has Been Signed on 08/20/2021 03:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 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
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Carmita Smith - CaregiverTIME COMPLETED:
04:00 PM
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
Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of investigating a complaint (#18-AS-20210818093958). During LPA Colvin's inspection, LPA Colvin observed additional items that needed to be addressed with the Administrator. Below is a summary of what was observed:

During LPA Colvin's inspection today, LPA Colvin was unable to access staff files, as they were not on site at the facility. Facilities are required to have all files available to Licensing to inspect at all times. Deficiency cited. Additionally, during LPA Colvin's review of resident files, LPA Colvin observed that one resident (R1) is classified as bedridden based on their Physician's Report from 2/25/21. The facility does not currently have a fire clearance for bedridden residents and does not have a program plan for caring for bedridden residents as well. Usually, a violation of the fire clearance would result in an immediate civil penalty of $500, however, LPA Colvin was informed by the Administrator that R1 has been served with a 30-day eviction notice. Health and Safety code 1569.49(c)(2)(A)(ii) states that if the eviction process has been initiated, the facility shall not be cited civil penalties. LPA Colvin will still be citing a deficiency and the facility shall either have R1 relocated or apply for bedridden clearance through Community Care Licensing. Deficiency cited.

An exit interview was conducted where this report and appeal rights were discussed. A copy of this report, LIC809D, 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
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 08/20/2021 03:50 PM - It Cannot Be Edited


Created By: Crystal Colvin On 08/20/2021 at 03:23 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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
HSC
1569.72(a)(2)

1
2
3
4
5
6
7
Residents requiring skilled nursing or intermediate care; bedridden residents: (a) ...no resident shall be admitted or retained in a residential care facility for the elderly if any of the following apply: (2) The resident is bedridden...This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to either relocate R1, apply for bedridden clearance. Licensee shall provide LPA Colvin with etiher the application for bedridden clearance, or proof of working on relocating R1 by Plan of Correction date of 8/23/21.
8
9
10
11
12
13
14
Based on record review, the Licensee did not comply with the above regulation with 1 of 4 residents (R1). LPA Colvin observed in R1's Phsycian's Report dated 2/25/21 that R1 is bedridden. The facility is licensed and has fire clearance for non-ambulatory only. This is an immediate safety risk for R1.
8
9
10
11
12
13
14
Type B
08/31/2021
Section Cited
CCR87412(g)

1
2
3
4
5
6
7
Personnel Records: (g) All personnel records shall be maintained at the facility and shall be available to the licensing agency for review. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to supply LPA Colvin with the background clearance inforamtion for all current staff as well as staff schedule by 8/27/21. Licensee to additionally either return all files to the facility or implement plan for Licensing to access files. Licensee to provide LPA Colvin with update by 8/31/21.
8
9
10
11
12
13
14
Based on observations and interviews, the Licensee did not comply with the above regulation with all staff files. LPA Colvin was unable to review staff files as they were not on site and not provided to LPA Colvin during the inspection. This is a potential safety and personal rights violation to all residents.
8
9
10
11
12
13
14
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: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


LIC809 (FAS) - (06/04)
Page: 2 of 2