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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366410678
Report Date: 10/15/2021
Date Signed: 10/15/2021 01:40:31 PM

Unsubstantiated


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
01/26/2021 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210126093050
FACILITY NAME:CANYON HILLS CARE HOMEFACILITY NUMBER:
366410678
ADMINISTRATOR:M. CASTELO/J GUBALANEFACILITY TYPE:
740
ADDRESS:7791 STEWART ROADTELEPHONE:
(909) 433-0612
CITY:COLTONSTATE: CAZIP CODE:
92324
CAPACITY:6CENSUS: 6DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Shirley Digma - CaregiverTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Resident was physically abused while in care

Facility staff did not ensure resident's personal care needs were met
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility to follow up on the complaint investigation with the allegation(s) above. LPA Colvin met with caregiver Shirley Digma and advised of the purpose of today's visit. Below is a summary of the findings of the investigation:

Regardign allegation "Resident was physically abused while in care": LPA Colvin reviewed resident's (R1) records and conducted interviews with staff, residents, and outside parties pertinent to R1's care. LPA Colvin was unable to confirm allegation of physical abuse as no evidence was provided of the abuse with the complaint, and LPA Colvin's investigation did not yield any proof of physical abuse either. Additionally, the allegation is in regards to an event that reportedly happened back in 2018. Due to the length of time that has passed between 2018 and the date the allegation was reported, there is little evidence remaining to investigate. Lastly, R1 was unable to be interviewed regarding the allegation as R1 passed away prior to the reporting of this complaint. Therefore, due to lack of evidence, the allegation "Resident was physically abused while in care" is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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 2
Control Number 18-AS-20210126093050
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: CANYON HILLS CARE HOME
FACILITY NUMBER: 366410678
VISIT DATE: 10/15/2021
NARRATIVE
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Regarding allegation "Facility staff did not ensure resident's personal care needs were met": LPA Colvin conducted a review of the facility's file for R1 and reviewed outside assessments and reviews for R1, which detailed medical care and appointment dates. The allegation regarding needs not being met is specifically in regards to podiatry care. LPA Colvin reviewed these records for R1 and observed that R1 had a podiatrist which R1 would see every 2-3 months for regular foot care. In review of these records, LPA Colvin confirmed that R1 was seen by their podiatrist at least 11 times between the years of 2017 - 2020. This is close to the estimated 12 times that R1 would be seen if scheduled every 3 months. LPA Colvin did note that there was a gap in care in the beginning of 2018 when R1's insurance had changed. There is documentation which shows that the facility was working with R1's insurance as well as a new podiatrist to get a referral for continued care for R1. Therefore, based on record review, the allegation "Facility staff did not ensure resident's personal care needs were met" is UNSUBSTANTIATED.

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 with caregiver Shirley Digma and a copy of this report was provided.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2