366424971-10-5-2022-56-AS-EMAN-CKHPYM-20221024114410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366424971
Report Date: 10/05/2022
Date Signed: 10/05/2022 03:01:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
09/29/2022 and conducted by Evaluator Natalie Ibarra

COMPLAINT CONTROL NUMBER: 56-AS-20220929100827

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:	10/05/2022
		UNANNOUNCED	TIME BEGAN:	09:56 AM
MET WITH:	Caitlin Belisle		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff do not answer residents' call buttons in a timely manner
Resident fell and received an injury due to insufficient staffing
Resident left in soiled diapers
Administrator is not at the facility for the required time
Insufficient staff resulting in residents needs not being met

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Ibarra made an unannounced visit to the facility to investigate the above allegations. LPA met with Lead Team Caregiver Caitlin Belisle. Administrator was contacted and informed about visit. Investigation consisted of pertinent interviews.

The first allegation indicates staff do not answer residents' call buttons in a timely manner. Interviews with Resident #1 (R1), Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), and Resident #5 (R5) stated staff do answer call buttons in a timely manner. Staff #1 (S1), Staff #2, and Staff #2 (S2) stated when a resident presses their call button staff does attend to the residents in a timely manner. S1, S2, and S3 stated if they are helping another resident, staff will notify resident who pressed call button that they will be right with them.

The second allegation indicates resident fell and received an injury due to insufficient staffing. R1 stated that they had slipped on the tile in their room. R1 pressed their call button and staff immediate came to assist them. R1 also stated Administrator was also present and assisted as well. S1 stated staff was present when

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

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-20220929100827

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HIGH DESERT RESIDENTIAL CARE, LLC	FACILITY NUMBER: 366424971
	VISIT DATE: 10/05/2022

NARRATIVE

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R1 fell and was helped immediately.

The third allegation indicates resident left in soiled diapers. R2, R3, and R4 stated that have never been left in soiled diapers for a long period of time. R2 and R3 stated staff check on them consistently and change them as needed. S1, S2, and S3 stated residents in diapers are checked multiple times throughout the day, about every 2 hours.

The fourth allegation indicates Administrator is not at the facility for the required time. S1 and S2 stated Administrator is at the facility every other week and will be there for the week. The weeks that the administrator is not at the facility, the facility owners are present. S1, S2, and S3 also stated Administrator is still involved when working offsite sending staff daily routine to be completed for the day.

The fifth allegation indicates Insufficient staff resulting in residents needs not being met. Interviews with S1, S2, and S3 stated the facility does have enough staff to attend to the residents needs. S1 stated facility has recently hire 2-3 new caregivers. R1, R2, R3, R4, and R5 stated they needs are being met with the staff present at the facility.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was discussed and provided to Lead Team Caregiver Caitlin Belisle.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2022

LIC9099 (FAS) - (06/04)

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