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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800086
Report Date: 11/25/2024
Date Signed: 11/25/2024 03:10:47 PM

Unsubstantiated


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
04/04/2024 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240404133620
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: 5DATE:
11/25/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Barbara SMith-enosTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Unlawful Eviction
Staff do not prevent resident from harming other resident(s) while in care
Food services are inadequate
Staff handle resident in a rough manner
Staff force resident to take medication causing injury
Staff threaten resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to further investigate into the above identified complaint allegations. LPA arrived at facility and was greeted at the door by Barbara Smith-enos, caregiver and granted entry and LPA explained the purpose of the visit.

Findings are based upon this investigation which included a tour of the physical plant of the facility, records review, interviews with the following: 5 out of 5 residents, and 3 of 3 staff.

It is alleged a wrongful eviction was given. Based on record review for LIC624 unusual incident report received for resident (R1) for April 06, 2024, indicate the following: 4/3/24 client hurt caregiver with a hand jab(s) on the neck. 3 day eviction notice given, 4/4/24 client asked for scissors, refused to say why.

Continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
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 4
Control Number 18-AS-20240404133620
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
VISIT DATE: 11/25/2024
NARRATIVE
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Said things that staff interprets as intent to harm house, staff, residents. 4/5/24 APS notified about self-neglect. CCA came to try help resolve. Client refused APS shelter resources list. 4/6/24, POA alerted Administrator about client’s possession of poison or intent to possess poison. Police notified client left facility and is missing. 4/6/24 client found at Riverside community hospital; police seen bringing clients medication administration record. 72 hours hold at hospital. Interview with Administrator indicated that a verbal and written 3 day eviction was given to resident on April 03, 2024. Resident went out to the hospital on April 6, 2024, after they walked out of the facility and police went to the facility on the that evening and retrieved residents’ medication and insurance, resident did not return to the facility.

It is alleged that staff do not prevent resident from harming other resident’s while in care. Interview with 2 of 5 residents, revealed that they have never witnessed any resident hitting or harming another residents. It was indicated that there is a resident that gets angry at times but does not hit anyone or harm them. Interview with Administrator indicated that there is a resident at the facility that that has moment of hot headiness that can last 20-30 seconds, however they have never aggressively physically touched any of the other residents. There is always staff on site and residents are supervised at all times. There as never been any reports from other resident or staff that they had been physically harmed by any resident.

It is alleged that food service is inadequate. LPA Martinez conducted a physical tour of the facility on today’s visit and observations revealed that facility has two refrigerators and a large pantry. It was observed that there were sufficient amount of quality and quantity of perishable and nonperishable food for residents. LPA observed the facility has a weekly menu posted in the kitchen and observed the food service to be well balanced with a variety of choices. LPA conducted interviews with staff and it was indicated that the facility does grocery days twice a week. Interview with residents revealed that they have never had an issue with food, snacks are always available and that they can request food out of the meals times and staff will get them food or prepare it for them.

It is alleged that staff handle residents in a rough manner. Interview with resident revealed that they have never been touched or spoken to in a rough aggressive manner. Resident also indicated that they have never witnessed any of the staff speak or handle any resident in a rough manner. Interview with Administrator

Continued on LIC9099-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20240404133620
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
VISIT DATE: 11/25/2024
NARRATIVE
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revealed that the only incident that they have been aware of it a staff entered a resident room for medication management and to get residents (R1) attention they tapped R1 in the knee as to R1 told staff not to touch them. Saff indicated that they have never witnessed another staff member handle a resident roughly at any moment.

It is alleged staff forced resident to take medication causing injury. Review of records obtained by LPA Sara Martinez on visit conducted on April 12, 2024, MAR sheet for April 2024 reflect that on various occasion R1 refused to take medication for diabetes management. Notes reflect that staff offered to R1 to take medication and all times it was refused. Interview with resident revealed that staff has never forced them to take medication or has caused an injury to them will doing medication management. Staff always helps and gives them their medication and they never had an issue. Interview with staff indicated that they don’t force resident to take medication and if they refuse that they try to get them to take medication but not force them to. Interview with Administrator revealed that staff are aware that resident’s have the right to refuse medication. When resident refuse medication staff will mark medication refusal on MAR.

It is alleged that staff threaten resident in care. Interview with staff revealed that they do not threaten any resident with evicting them since they can’t do that and that they have never witnessed the Administrator to threaten anyone with that either. Interview with Administrator indicated that a verbal and written 3 day eviction was given to resident on April 03, 2024. Interview with resident indicated that they have never been asked to leave, threatened, or given an eviction notice. They indicated that they have not seen any staff do that to them or anyone in the facility. Based on record review for LIC624 unusual incident report received for resident (R1) for April 06, 2024, indicate the following: 4/3/24 client hurt caregiver with a hand jab(s) on the neck. 3 day eviction notice given, 4/4/24 client asked for scissors, refused to say why. Said things that staff interprets as intent to harm house, staff, residents. 4/5/24 APS notified about self-neglect. CCA came to try help resolve. Client refused APS shelter resources list. 4/6/24, POA alerted Administrator about client’s possession of poison or intent to possess poison. Police notified client left facility and is missing. 4/6/24 client found at Riverside community hospital; police seen bringing clients medication administration record. 72 hours hold at hospital.

Continued on LIC9099-C
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240404133620
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
VISIT DATE: 11/25/2024
NARRATIVE
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Based on the information mentioned above, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with facility representative and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4