331800086-8-16-2021-18-AS-JESL-C7ZULP-20211021154103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 08/16/2021
Date Signed: 08/16/2021 01:23:19 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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/16/2020 and conducted by Evaluator Javina George

COMPLAINT CONTROL NUMBER: 18-AS-20200916091515

FACILITY NAME:	CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)		FACILITY NUMBER:	331800086
ADMINISTRATOR:	CASTRO, MICHAEL		FACILITY TYPE:	740
ADDRESS:	3615 CROWELL AVE		TELEPHONE:	(951) 324-1601
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	6	CENSUS: 6	DATE:	08/16/2021
		UNANNOUNCED	TIME BEGAN:	11:36 AM
MET WITH:	Administrator Daniel Barrett		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not maintain facility at a comfortable temperature.
Resident missed medication.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Javina George arrived unannounced at the facility to investigate as well as to deliver findings for the allegation(s) listed above. LPA met with Administrator Daniel Barrett and explained the purpose of the visit as well as the elements of the allegations. The allegation(s) were investigated by the department. The investigation consisted of observation, interviews and record review.

Allegation: Staff do not maintain facility at a comfortable temperature.
Upon entry to the facility LPA observed the facility to be at a cool and comfortable temperature, as it was 90 degrees Fahrenheit at the time of the visit. LPA conducted interviews with five of the six residents, one resident was asleep at the time of LPAs visit. LPA interviewed Resident # 2 (R2) whom stated that they were not able to remember if it were too cold or not, because it was a long time ago, and that everything was fine now, as they were smiling. LPA did observe there to be a white rectangular shaped heater on wheels available for R2 to use, should the temperature become too cold. LPA interviewed four other residents whom stated that there were not any issues with the temperature of the

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

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 18-AS-20200916091515

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
RIVERSIDE, CA 92507

FACILITY NAME: CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)	FACILITY NUMBER: 331800086
	VISIT DATE: 08/16/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

facility, and that they had an extra blanket to use should they become cold. Administrator did state that R2 did complain about their room being too cold, and that the facility immediately acted on the complaint. Administrator revealed to LPA the measures that the facility has taken to assist with providing a comfortable temperature. Such as a providing a heater, closing the vent, and covering up the window from the sun room that R2 felt the draft was coming from. R2s bed is in between a small window and wall to the sun room. Based on observation and interview the allegation of Staff do not maintain facility at a comfortable temperature is UNSUBSTANTIATED.

Allegation: Resident missed medication.
LPA reviewed the Medical Authorization form (MAR) for September 2020. R2 is prescribed to have Magnesium Duloxetine, Vitamin B12, Vitamin D3, multivitamin, and Sulfamethoxazole to be given in the morning . Per the September 2020 MAR for R2, all medications were signed off as being administered except for the AM medication on September 20, 2020, for multiple residents. There was not an explanation provided on the MAR. Per the facility's communication log notes dated 9/20/20, state that all medications were given for every resident. Administrator stated that he believes that the staff forgot to sign them off. LPA conducted interviews and R2 stated that they are getting their medication everyday. There was not enough evidence to prove whether there were missed medications or not. Based on observation, interview and record review the allegation of Resident missed medication is UNSUBSTANTIATED. A finding that the 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted and a copy of this report was provided to Administrator Daniel Barrett.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 08/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2