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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 11/29/2021
Date Signed: 11/29/2021 05:12:33 PM

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
03/16/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200316140401
FACILITY NAME:CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)FACILITY NUMBER:
331800086
ADMINISTRATOR:CASTRO, MICHAELFACILITY TYPE:
740
ADDRESS:3615 CROWELL AVETELEPHONE:
(951) 324-1601
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 6DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Danny Barrett - AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Facility grounds is in disrepair

Staff is mishandling clients medication while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of continuing investigation of a complaint with the above allegation(s). LPA Colvin met with Administrator Danney Barrett, and informed him of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Facility grounds is in disrepair": LPA Colvin observed numerous cracks in the concrete driveway, some of which caused the ground to be unlevel. LPA Colvin placed her writing pen next to the crack and measured the difference between the height difference of both sides of the crack to be approximately one inch. This is a safety hazard for residents, especially the non-ambulatory residents that this facility is licensed to retain, as they require mobility devices to assist with their movement. LPA Colvin additionally observed a hole in-between the brick walkway in the backyard, which leads to the Administrative office. While this hole was marked by a step ladder and a hazard cone, Administrator Danny informed LPA Colvin that it has been that way for approximately one month due to an ongoing investigation into the sprinklers and pipes.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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 8
Control Number 18-AS-20200316140401
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: 11/29/2021
NARRATIVE
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Therefore, based on observations and interview, the allegation "Facility grounds is in disrepair" is SUBSTANTIATED.

Regarding allegation "Staff is mishandling clients medication while in care": LPA Colvin interviewed Administrator Danny Barrett and reviewed physical medication bottles and records from past resident (R1). LPA Colvin observed that while the facility's records for R1's medication Carvedilol stated that the staff were to administer 6.25 mg tablets broken into halves twice daily, the bottle for R1's medication was labeled as being 3.125 mg tablets, which were to be taken twice daily. Therefore, if the staff were cutting the 3.125 mg tablets, as instructed on the facility's medication records, then R1 was only getting half the prescribed dose of medication. Therefore, based on record review, the allegation "Staff is mishandling clients medication while in care" is SUBSTANTIATED.

A finding that the complaint is SUBSTANTIATED means that the allegation(s) is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted with Administrator Danny Barrett, and a copy of this report, LIC9099D, and appeal rights was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 18-AS-20200316140401
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: 11/29/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/29/2021
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights...in Privately Operated Facilities: (a) In addition to the rights listed...residents...shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff...to meet their needs. This requirement was not met by:
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Licensee agrees to conduct a self-audit of all resident medications and medication records to ensure that staff instructions reflect what the physician has prescribed. Licensee may self-certify to LPA Colvin once the self-audit is complete. Self-certification to be submitted by Plan of Correction date of 11/29/21.
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Based on record review, the Licensee did not comply with the above regulation with at least one resident. LPA Colvin observed that facility records instructed staff to cut R1's Carvedilol, though R1's medication bottles did not reflect this instruction. This was an immediate health risk for R1.
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Type B
12/13/2021
Section Cited
CCR
87307(d)(2)
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Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by:
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Licensee agrees to have areas in disrepair mentioned in report fixed and maintained in a healthful manner. Licensee to provide LPA Colvin with photographic proof of repaired areas by Plan of Correction date of 12/13/21.
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Based on observations, the Licensee did not comply with the above regulation with two areas of the facility. LPA Colvin observed cracks in the driveway making the ground unlevel by 1 inch as well as a hole in the walkway in the backyard. This is a potential safety risk for residents in care.
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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: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 8
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
03/16/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200316140401

FACILITY NAME:CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)FACILITY NUMBER:
331800086
ADMINISTRATOR:CASTRO, MICHAELFACILITY TYPE:
740
ADDRESS:3615 CROWELL AVETELEPHONE:
(951) 324-1601
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 6DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Danny Barrett - AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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9
Staff is not properly safeguarding client's personal information

Staff is not properly maintaining the facility
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of continuing investigation of a complaint with the above allegation(s). LPA Colvin met with Administrator Danney Barrett, and informed him of the purpose of today's visit. Below is a summary of the findings of the investigation:


Regarding allegation "Staff is not properly safeguarding client's personal information": LPA Colvin toured the facility and requested to see where the facility's files were stored. LPA Colvin observed that resident files were kept locked in the medication cabinet, which was locked at all times during LPA Colvin's visit, except when LPA Colvin requested access. LPA Colvin additionally inquired about where staff files were kept, and Administrator Danny Barrett informed LPA Colvin that all staff files are kept on a computer drive, which only he has access to. LPA Colvin did not observe any private client information outside of the locked cabinet during the inspection. Therefore, due to observations, interview, and lack of evidence supporting the claim, the allegation of "Staff is not properly safeguarding client's personal information" is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 18-AS-20200316140401
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: 11/29/2021
NARRATIVE
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Regarding the allegation "Staff is not properly maintaining the facility": This allegation was specifically in relation to the facility's kitchen stove, which LPA Colvin did not observe any concerns with during the investigation. LPA Colvin additionally interviewed Administrator Danny Barrett regarding if there had been any issues with the stove, and Danny reported to LPA Colvin that they had one which was not working, so the landlord replaced it with a new one. Administrator Danny was able to show LPA Colvin on his computer and email exchange between himself and the landlord of the property in February of 2020, wherein the landlord states that they will come take a look at the problem. No further evidence was provided to LPA Colvin regarding this allegation. Therefore, based on observations, interviews, and record review, the allegation "Staff is not properly maintaining the facility" 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 Danny Barrett.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 8
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
03/16/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200316140401

FACILITY NAME:CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)FACILITY NUMBER:
331800086
ADMINISTRATOR:CASTRO, MICHAELFACILITY TYPE:
740
ADDRESS:3615 CROWELL AVETELEPHONE:
(951) 324-1601
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 6DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Danny Barrett - AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
1
2
3
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5
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7
8
9
Staff is not allowing client to seek timely medical attention

Staff is denying CCL representatives from inspecting the facility
INVESTIGATION FINDINGS:
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3
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5
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7
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13
Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of continuing investigation of a complaint with the above allegation(s). LPA Colvin met with Administartor Danney Barrett, and informed him of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regarding allegation "Staff is not allowing client to seek timely medical attention": LPA Colvin reviewed the file for current resident, R2. LPA Colvin quickly observed several documents in R2's file in regards to their prescribed inhaler. Such documents, including copy of prescription predate this complaint. This allegation was specific to R2 needing medication (inhaler) and staff not being able to provide medication as R2 was not prescribed an inhaler, as staff would not take R2 to the doctor. Based on the copy of the prescription for the inhaler which dates back to before this complaint was filed, the allegation of "Staff is not allowing client to seek timely medical attention" is UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 18-AS-20200316140401
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: 11/29/2021
NARRATIVE
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Regarding allegation "Staff is denying CCL representatives from inspecting the facility": LPA Colvin toured the facility, specifically focusing on where medications were stored, as well as what was stored in the Administrative office in the backyard. This allegation was specific to medication being kept in a secondary location (file cabinet in office), which Licensing was not given access to. LPA Colvin was granted access by the Administrator to medication both in the main storage area for the medication in the kitchen, as well as to the cabinet in the office. LPA Colvin confirmed the presence of medication in the cabinet in the office, but LPA Colvin was granted access to both the office and the cabinet by Administrator Danny Barrett without any difficulty. Therefore, based on observations, the allegation "Staff is denying CCL representatives from inspecting the facility" is UNFOUNDED.

We have found the complaint is unfounded, meaning that the allegations are false, could not have happened and are without a reasonable basis.

LPA Colvin conducted an exit interview with Administrator Danny Barrett and a copy of this report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 8