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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366424971
Report Date: 03/02/2023
Date Signed: 03/02/2023 02:23:27 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
02/24/2023 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230224121634
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: 11DATE:
03/02/2023
UNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Stacy Hartman, CaregiverTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility heater in disrepair.
Staff do not provide nutritious meals.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rayshaun Nickolas made an unannounced visit to the facility to deliver the finding on the above allegations. LPA met with Stacy Hartman and explained the purpose of the visit. Hartman called the Licensee, and Licensee was unavailable to attend. However, LPA discussed this report with the Licensee over the phone and the Licensee gave permission for Hartman to sign this report on their behalf. The investigation consisted of file reviews, facility tour, and interviews with relevant parties.

Allegation #1 "Facility heater in disrepair". The reporting party (RP) alleged that they have a portable heater in their room registering at 80 degrees but it is still very cold even with a heavy jacket on. The RP also alleged that their neighbor has two (2) portable heaters in their room but their neighbor is still cold. LPA interview with staff #1 (S1) revealed that the heater was not working in certain sections of the facility but it was repaired this morning, March 2, 2023. LPA interview with the Licensee revealed that the facility has central heating; however, they discovered that no heat was coming from the vents in two (2) clients rooms. The Licensee stated that they called their repair man right away to assess the situation and provided the clients without heat with portabe heaters.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
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 3
Control Number 56-AS-20230224121634
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: 03/02/2023
NARRATIVE
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The Licensee stated that high desert air came out to conduct an assessment and determined that the concentrator was not working. The Licensee further stated that the heating system was fixed this morning, March 2, 2023. LPA interview with client #1 (C1) revealed that the facility finally fixed the problem. LPA observed that the thermostat recorded the indoor temperature at 79 degrees fahrenheit. The finding is Unsubstantiated.

Allegation #2 "Staff do not provide nutritious meals". The RP alleged that the staff serves residents can and frozen foods. The RP further alleged that peanut butter and jelly and apple sauce for lunch which is not nutritious. LPA observed that facility had more than a seven (7) day supply of non-perishable foods and a two (2) day supply of perishable food. LPA observed that the facility's fresh fruits and vegetables were in good condition. LPA observed fresh fruits and vegetables at the facility. LPA also observed a weekly food menu located in the facility's kitchen. LPA observed the clients were served bacon and ham sandwiches with lettuce, tomatoes and mayonnaise for lunch. LPA also observed that the clients were served fruit cocktail with their sandwiches. The finding is Unsubstantiated.

A finding of 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 copy of this report was provided.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3