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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 07/27/2023
Date Signed: 07/27/2023 03:31:01 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
02/25/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200225092314
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:
07/27/2023
UNANNOUNCEDTIME BEGAN:
01:55 PM
MET WITH:Danny Barrett, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff do not have proper training
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegation listed above. LPA was accompanied by a Community Care Licensing approved ASL interpreter to assist LPA's communications with facility staff and residents.
LPA met with Administratior (AD) Danny Barrett and explained the purpose of the visit.
During today's visit, LPA interviewed one (1) resident, one (1) staff and requested pertinent documents.
Regarding the allegation "Staff do not have proper training", it was alleged that Staff #1 (S1) had not been properly trained to provide assistance to Resident #1 (R1) for their medical condition. Interview with AD indicated all staff had been trained but when LPA requested 2020 training records for S1 they were unable to be located. S1 is no longer employed at the facility and could not be interviewed.
Based on interviews conducted and a lack of records to be reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list and Appeal Rights.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023
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-20200225092314
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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: 07/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/11/2023
Section Cited
CCR
87411(d)(3)
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Personnel Requirements- General, (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This...shall provide knowledge of ...(3)Skill and knowledge required to provide necessary resident care...to...residents. This requirement was not met as evidenced by:
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The Licensee will ensure all staff are provided training by a licensed medical professional to properly care for R1's medical condition. Proof of such training will be submitted to CCL by the POC due date 8/11/2023.
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The Licensee did not ensure all staff were trained to provide necessary care for residents. Based on interviews and records reviewed, there is no evidence that S1 was trained to provide R1 with assistance with their medical condition. This poses a potential health, safety, and personal rights
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(continued from left) risk to 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: Jazmond D Harris
LICENSING EVALUATOR NAME: Tricia Danielson
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2