366424971-9-20-2022-56-AS-KCLS-CM6VNK-20221216153516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366424971
Report Date: 09/20/2022
Date Signed: 09/20/2022 03:46:32 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
09/13/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220913104058

FACILITY NAME:	HIGH DESERT RESIDENTIAL CARE, LLC		FACILITY NUMBER:	366424971
ADMINISTRATOR:	YIP, TERESA		FACILITY TYPE:	740
ADDRESS:	8980 JOSHUA LANE		TELEPHONE:	(760) 853-0464
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY:	12	CENSUS: 11	DATE:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Caitlin Belisle- Lead Support Staff		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff do not answer residents' call buttons in a timely manner.
Facility does not meet residents' dietary needs.
Facility is not maintained clean and sanitary.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen an conducted an unannounced visit to initiate a complaint investigation for the allegations above. LPA Allen met with Caitlin Belisle- Lead Support Staff who was informed of the purpose of the visit. LPA, also called the Administrator Teresa Yip and informed her of the purpose of my visit and asked if Caitlin could sign documents once complete and she said yes.

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

Allegation #1-Staff do not answer residents' call buttons in a timely manner.

LPA Allen interviewed residents and found that staff were responding to the residents call buttons in a timely manner.

continued .....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20220913104058

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: 09/20/2022

NARRATIVE

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Allegation #2- Facility does not meet residents' dietary needs.

LPA Allen observed 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.

Allegation #3- Facility is not maintained clean and sanitary.

LPA Allen observed the facility to be clean, sanitary, and free of bad odors.

Based on observation, interviews conducted, and record review the three (3) 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.

An exit interview was conducted, and this report and appeal rights was discussed and provided to Team Lead Caitlin Belisle at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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