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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 09/15/2022
Date Signed: 09/15/2022 02:58:29 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
09/14/2022 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220914185645
FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:66CENSUS: 60DATE:
09/15/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Maria Arruaga - AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff illegally evicted resident

Facility did not have hot water
INVESTIGATION FINDINGS:
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On today's date, Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initiating an investigation with the above allegation. LPA Colvin met with Adminsitrator Maria Arruaga and informed her of the purpose of today's inspection. Below is a summary of the findings of the investigation:

Regarding allegation “Staff illegally evicted resident”: LPA Colvin interviewed Administrator Arruaga and reviewed relevant records to the allegation, such as an email from the Administrator dated 9/14/22, which was the facility's Termination Notice to resident (R1)'s family. The notice states "We became aware that we can no longer meet his needs at Caleo Bay.....Discharge from Caleo Bay will be effective today". LPA Colvin additionally observed staff charting for 9/14/22 memorilizing the same notice. Administrator Arrugua additionally attached the first nine pages of the signed Admissions Agreement in the email. LPA Colvin reviewed this same Admissions Agreement and observed that in accordance with Title 22 Regulations, the Admissions Agreement states that the facility may give a 30-day Notice of Termination if there is an unmet need.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
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 4
Control Number 18-AS-20220914185645
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 09/15/2022
NARRATIVE
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Additionally, the unmet need must be confirmed/documented through a reassessment of the resident. LPA Colvin observed that the Notice of Termination for R1 did not follow these requirements, as outlined in the Admissions Agreement. Title 22 Regulations does not permit for facilities to evict residents without a 30-day notice, unless a 3-day notice is approved ahead of time by Community Care Licensing. Therefore, based on interviews and record review, the allegation "Staff illegally evicted resident" is SUBSTANTIATED.

Regarding allegation "Facility did not have hot water": LPA Colvin observed a staff note in R1's charting on 9/11/22 where a visitor of R1 complained about there not being hot water in Room #46. During today's inspection, LPA Colvin measured the hot water from the faucet in the sink of Room #46, and after waiting for several minutes, observed that the maximum temperature LPA Colvin measured was 92.6. LPA Colvin additionally measured the hot water from the sink faucet in Room #36, and the maximum hot water temperature LPA Colvin read for that room was 86.7. LPA Colvin waited ample amount of time before each final measurements was logged, and observed that prior to reaching their maximum temperature, the climb in degrees was around .1 every 30 seconds. At the time of the final measurements, LPA Colvin had not observed any change in temperature for over 1 minute. Title 22 Regulations requires hot water to be at least 105, but not more than 120. Therefore, while the facility does have the ability to have hot water (based on water temperature being more than that of non-heated water), the hot water coming from the resident faucets (at least in two rooms) is not hot enough according to Title 22 Regulations. Therefore, based on observations, the allegation "Facility did not have hot water" 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.

Due to observations made by LPA Colvin, the facility was cited and deficiencies noted on LIC 9099 D. An exit interview was conducted where this report and appeal rights were discussed. A copy this report, LIC 9099D, and appeal rights were provided to Administrator Maria Arruaga during the exit interview.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20220914185645
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/16/2022
Section Cited
CCR
87468.2(a)(20)
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Additional Personal Rights of Residents in ...Facilities: (20) To be protected from involuntary transfers, discharges, and evictions. A licensee shall not involuntarily transfer or evict residents...and shall comply with all eviction and relocation protections for residents.... This requirement was not met by:
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Licensee agrees to recind the eviction notice sent to the family, and provide LPA Colvin with a copy of an email sent to the family detailing the recintion of the illegal eviction. This does not prohibit the facility from issuing a 30-day eviction, should the follow the proper procedure. Additionally, Licensee agrees to
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Based on record review, the Licensee did not comply with the above regulation with one resident (R1). Administrator provided R1's family with an eviction notice on 9/14/22 which was effective immediately. The facility also did not conduct a reassessment of R1. This is an immediate personal rights violation of R1.
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have Administrator review Title 22 Reglation Section 87224 Eviction Procedures. Administrator to provide LPA Colvin with Self-Certification of completion as well as Statement of Understanding regarding proper eviction procedures. Email, self-certification, and Statement due by 9/16/22.
Type B
09/30/2022
Section Cited
CCR
87303(e)(2)
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Maintenance and Operation: (e) Water supplies and plumbing fixtures shall be maintained as follows: (2) Faucets used by residents for personal care... shall deliver hot water. Hot water temperature controls shall be...a temperature of not less than 105 degree F... This requirement was not met by:
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Licensee agrees to adjust the settings on the water heater and re-measure the maximum hot water tempurature in 3 resident bathrooms in each wing of the facility. Licensee to provide LPA Colvin with readings for each room, confirming that the tempurature is inbewteen
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Based on observations, the Licensee did not comply with the above regulation with at least two resident bathrooms (#46 & #36). LPA Colvin observed a maximum hot water tempurature in Room #46 of 92.6 degrees, and 86.7 degrees in Room #36. This is a potential health risk for residents in care.
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105 and 120 in resident bathrooms. Readings to be provided to LPA Colvin by Plan of Correction date of 9/30/22.
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: 09/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4