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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366424971
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:52:30 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:
06/27/2023
UNANNOUNCEDTIME BEGAN:
12:18 PM
MET WITH:Delia Alpez, caregiverTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents have had multiple falls while in care.
Staff are not meeting the needs of residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rayshaun Nickolas visited the facility unannounced to deliver the finding on the above allegations. LPA met with caregiver Delia Alpez and explained the purpose of the visit. LPA Nickolas' also discussed this report with the Licensee.The investigation included file reviews, a tour of the facility, and interviews with relevant parties.

Allegation #1 "Residents have had multiple falls while in care". The allegation alleged that client # 1 (C1) fell in the shower and fractured their hip. The allegation also alleged that client # 2 (C2) had multiple falls. LPA interview with the Licensee revealed that C1 did not fall at the facility and break their hip. The Licensee stated that C2 was placed in the facility because of their fall risk. LPA file review of C1's records revealed that C1 is bedridden. LPA file review of C2's records revealed that C2's preplacement appraisal form LIC 603 does note C2 as a fall risk due to their medical condition. LPA facility tour revealed that the facility is clean, in good repair, and free of tripping hazards. Therefore, the finding is unsubstantiated. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
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 2
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: 06/27/2023
NARRATIVE
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Allegation #2 “Staff are not meeting the needs of residents in care”. The allegation alleged that the facility is short-staffed. LPA observed two (2) facility staff working at the facility, and the two (2) staff members met the client's needs. LPA facility file review revealed that the facility employs two (2) members during the day shifts and one (1) overnight staff. Therefore, the finding is unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

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: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2