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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 04/13/2023
Date Signed: 04/13/2023 01:35:13 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/25/2021 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210125111316
FACILITY NAME:CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)FACILITY NUMBER:
331800086
ADMINISTRATOR:CASTRO, MICHAELFACILITY TYPE:
740
ADDRESS:3615 CROWELL AVETELEPHONE:
(626) 701-8960
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 6DATE:
04/13/2023
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Danny Barrett, AdministratorTIME COMPLETED:
01:42 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff failed to treat resident with dignity and respect.
Staff mismanaged resident's medication.
Staff failed to provide a comfortable and safe environment for the resident.
Staff failed to provide resident with privacy.
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 Administrator Danny Barrett and explained the purpose of the visit. The investigation consisted of file reviews and interviews with relevant parties.

Allegation #1: “Staff failed to treat resident with dignity and respect”. The allegation alleged that staff #1 (S1) has been picking on resident # 1 (R1) for the last three (3) months by making inappropriate comments and spreading rumors about R1 to the other facility staff members. LPA Nickolas' interview with the facility's administrator revealed that the administrator denies that facility staff members failed to treat R1 with dignity and respect. LPA Nickolas' interviews with residents revealed that no residents witnessed or admitted to the staff's failure to treat residents with dignity and respect. 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: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
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 18-AS-20210125111316
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA
FACILITY NAME: CALIFORNIA HOME FOR THE ADULT DEAF (CHAD)
FACILITY NUMBER: 331800086
VISIT DATE: 04/13/2023
NARRATIVE
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Allegation #2 “Staff mismanaged resident's medication”. The allegation alleged that three (3) times, S1 administered the old medication to R1, not the new medication. LPA Nickolas' interview with the facility's administrator revealed that the administrator checks to see if the medication is expired. LPA Nickolas' interviews with residents revealed that no residents witnessed or admitted to staff mismanaging their medication. The finding is Unsubstantiated. There is no evidence or witnesses to corroborate the allegation.

Allegation #3 “Staff failed to provide a comfortable and safe environment for the resident”. The allegation alleged that R1 does not feel comfortable or safe when S1 is around. LPA Nickolas’ interviews with residents revealed that no residents witnessed or admitted to staff failing to provide a comfortable and safe environment for the residents. There is no evidence or witnesses to corroborate the allegation.



Allegation #4 “Staff failed to provide resident with privacy”. Allegation alleged that S1 does not give R1 any privacy in their room. LPA Nickolas’ interviews with residents revealed that no residents witnessed or admitted to staff failing to provide residents with privacy.

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: 04/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2