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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 10/04/2021
Date Signed: 10/04/2021 09:43:25 AM

Substantiated


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
09/28/2021 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210928145559
FACILITY NAME:CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)FACILITY NUMBER:
331800086
ADMINISTRATOR:DANNY BARRETTFACILITY TYPE:
740
ADDRESS:3615 CROWELL AVETELEPHONE:
(626) 701-8960
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 6DATE:
10/04/2021
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Danny Barrett, AdministratorTIME COMPLETED:
09:45 AM
ALLEGATION(S):
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Administrator did not allow resident to return to facility due to their medical health decision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Administrator, Danny Barrett, and informed him of the purpose of the visit.

Pertaining to the allegation, "Administrator did not allow resident to return to facility due to their medical health decision," it was alleged Administrator, Danny Barrett, did not allow Resident One (R1) to return to the facility on September 11, 2021 due to not having received a COVID-19 vaccination. The LPA initiated the investigation into the allegation on October 04, 2021; staff interviews were conducted, records reviewed, and copies of pertinent documentation were obtained. Administrator Barrett was interviewed and denied the allegation; he reported the resident was only been asked to show proof of a negative COVID-19 test result. Copies of email correspondence between Barrett and R1's responsible party reveal Barrett required proof of COVID-19 vaccination prior to allowing R1 to return to the facility. This posed a risk to the personal rights of the resident in care. Therefore, based on records, this allegation is deemed SUBSTANTIATED. A finding that the complaint is
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
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 3
Control Number 18-AS-20210928145559
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: 10/04/2021
NARRATIVE
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substantiated means the allegation is valid because the preponderance of the evidence standard has been met. A citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted with Administrator Barrett, in which this report was reviewed and a copy provided. A copy of LIC 811 and Appeal Rights were also issued.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210928145559
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/04/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/08/2021
Section Cited
CCR
87468.1(a)(16)
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PERSONAL RIGHTS OF RESIDENTS IN ALL FACILITIES: Residents in all residential care facilities for the elderly shall have all of the following personal rights: To receive or reject medical care or other services. This requirement was not met, as evidenced by: Based on records, the Licensee did not ensure
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Administrator stated written proof will be sent to the Department to indicate the resident may return without any proof of COVID-19 vaccination or testing.
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R1 was permitted to reject medical care or
other services. Copies of email correspondence between Barrett and R1's responsible party reveal Barrett required proof of COVID-19 vaccination prior to allowing R1 to return to the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Stephanie Torres
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3