365530072-10-11-2023-56-AS-EMAN-CX5RGL-20231031130051

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 365530072
Report Date: 10/11/2023
Date Signed: 10/11/2023 02:19:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
07/11/2023 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230711091759

FACILITY NAME:	VILLA DESCANSO DE AMOR		FACILITY NUMBER:	365530072
ADMINISTRATOR:	THOMPSON, GABRIELA		FACILITY TYPE:	740
ADDRESS:	15453 ELM LANE		TELEPHONE:	(909) 393-6201
CITY:	CHINO HILLS	STATE: CA	ZIP CODE:	91709
CAPACITY:	6	CENSUS: 6	DATE:	10/11/2023
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Joaquin Thompson		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff handled resident in an aggressive manner resulting in injury.
Facility did not seek medical attention for resident.
Staff yelled at resident.
Facility did not allow resident to have visitors.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility Administrator Joaquin Thompson and explained the purpose of the visit. The investigation consisted of interviews and a review of records.

First allegation, Staff handled resident in an aggressive manner resulting in injury. During interview with Staff #1 (S1) and Staff #2 (S2) both denied handling Resident #1 in a rough manner or injuring Resident #1 (R1). LPA asked Staff #1 (S1) and Staff #2 (S2) if they have witnessed staff handling Resident #1 (R1) in a rough manner Staff #1 (S1) and Staff #2 (S2) stated “No”. LPA interviewed Resident # 2, Resident #3, Resident #4, and Resident #5 and all denied witnessing Resident # 1 (R1) being handled in a rough manner by staff. LPA asked Resident 2-5 if staff has handled them in a rough manner all stated “No” Resident #3 (R3) and Resident #4 (R4) stated that facility staff is kind and attend to their needs.

Second allegation, Facility did not seek medical attention for resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230711091759

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: VILLA DESCANSO DE AMOR	FACILITY NUMBER: 365530072
	VISIT DATE: 10/11/2023

NARRATIVE

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During interview with Staff #1 (S1), and Staff #2 (S2), both stated that facility has no reports, incidents, or physical observations indicating that Resident #1 needed medical attention. LPA conducted a record review of Resident #1 records and LPA did not find any Special Incident Reports (SIR's) pertaining to Resident #1.

Third allegation, Staff yelled at resident. During interviews with Staff #1 (S1) and Staff #2 (S2) both staff denied yelling at Resident #1. LPA conducted interviews with Resident # 2, Resident #3, Resident #4, and Resident #5. All residents denied being yelled at by staff or witnessing staff yell at Resident # 1.

Fourth allegation, Facility did not allow resident to have visitors. LPA conducted a record review upon record review LPA observed a conversation exchange via text message between staff and responsible party in which staff indicated to Resident #1 responsible party that visitations were not being denied to family member[s] however, visitations were to be held outside facilities front porch. Based on the evidence obtained during the course of the investigation, LPA has determined that the above allegations are Unsubstantiated.

Unsubstantiated; meaning that 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 where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Joaquin Thompson at the end of the visit.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

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