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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366424971
Report Date: 06/29/2022
Date Signed: 06/29/2022 01:44:37 PM

Unsubstantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/22/2022 and conducted by Evaluator Ryan Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220622140851
FACILITY NAME:HIGH DESERT RESIDENTIAL CARE, LLCFACILITY NUMBER:
366424971
ADMINISTRATOR:YIP, TERESAFACILITY TYPE:
740
ADDRESS:8980 JOSHUA LANETELEPHONE:
(760) 853-0464
CITY:YUCCA VALLEYSTATE: CAZIP CODE:
92284
CAPACITY:12CENSUS: 12DATE:
06/29/2022
UNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Caitlin Belisle- Team LeadTIME COMPLETED:
01:53 PM
ALLEGATION(S):
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Staff do not shower residents regularly.
Facility does not meet residents' dietary needs.
Facility is not maintained clean and sanitary.
Staff do not answer residents' call buttons in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility for the purpose of initiating an investigation and delivering findings for the above complaint allegations. LPA Gardner met with Team Lead Caitlin Belisle and explained the reason for the visit. At the time of visit there were three (3) staff and twelve (12) residents present.

During today’s visit, LPA Gardner toured the facility, interviewed staff members, interviewed residents, and reviewed facility records.

For allegation, Staff do not shower residents regularly. LPA Gardner found that the residents are on shower schedule. The resident’s on hospice receive a shower three (3) times a week.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
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 2
Control Number 56-AS-20220622140851
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
, CA 92507
FACILITY NAME: HIGH DESERT RESIDENTIAL CARE, LLC
FACILITY NUMBER: 366424971
VISIT DATE: 06/29/2022
NARRATIVE
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The resident’s that are not on hospice receive a shower two (2) times a week.

For allegation, Facility does not meet residents' dietary needs. LPA Gardner observed a one (1) week supply of non-perishable food and two (2) days of perishable food. The amount of food in the facility meets the standard for licensing requirements. The residents are fed three meals a day and offered snacks throughout the day. The facility has a monthly meal menu that includes protein, fruit, and vegetables.

For allegation, Facility is not maintained clean and sanitary. LPA Gardner observed the facility to be clean, sanitary, and free of bad odors.

For allegation, Staff do not answer residents' call buttons in a timely manner. LPA Gardner found that staff were responding to the residents call buttons in a timely manner.

Based on observation, interviews conducted, and record review the four (4) allegations listed above are deemed UNSUBSTANTIATED.

A finding that a complaint is 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.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Team Lead Caitlin Belisle, along with a copy of the appeal rights.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2