366426555-9-14-2021-18-AS-EMAN-CCZW45-20220330165658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 366426555
Report Date: 09/13/2021
Date Signed: 09/14/2021 09:06:58 AM

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
09/07/2021 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210907121129

FACILITY NAME:	APPEARANCE QUALITY HOME		FACILITY NUMBER:	366426555
ADMINISTRATOR:	RILEY, RACHEL		FACILITY TYPE:	740
ADDRESS:	10752 OAKWOOD AVE.		TELEPHONE:	(760) 956-2800
CITY:	HESPERIA	STATE: CA	ZIP CODE:	92345
CAPACITY:	6	CENSUS: 4	DATE:	09/13/2021
		UNANNOUNCED	TIME BEGAN:	03:05 PM
MET WITH:	Blanca Gonzalez		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff member physically abused resident while in care.
Staff threatened resident while in care.
Staff moved resident without consent/illegal eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams made an unannounced visit to the facility in order to initiate a complaint investigation into the above allegations. LPA met with Caregiver, Blanca Gonzalez and discussed the purpose of the visit. The Administrator, Rachel Riley, was unavailable at the time of visit; however, LPA spoke with Riley over the phone. The investigation consisted of records review and interviews with staff and residents.

In regards to allegation #1, LPA interviewed Resident #1 (R1) who stated that Staff #1 (S1) slapped R1 in the face and pulled R1's hair; however, R1 could not recall the time of the incident or if there was any eyewitnesses. R1 could not recall further details. LPA interviewed S1, Staff #2 (S2), and Staff #3 (S3) who all denied physically abusing the residents nor did they witness other staff members physically abuse residents. LPA interviewed Resident #2 (R2) and Resident #3 (R3) who denied being physically abused nor did they witness any physical abuse by staff members. Both R2 and R3 stated that facility staff have treated them well. LPA interviewed Witness #1 (W1) who stated that R1 had reported that they were being physically abused.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Stephanie Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

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 18-AS-20210907121129

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: APPEARANCE QUALITY HOME	FACILITY NUMBER: 366426555
	VISIT DATE: 09/13/2021

NARRATIVE

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W1 stated that R1 was checked for any marks/injuries/bruising but did not find any.

In regards to allegation #2, LPA interviewed R1 who stated that facility staff would threaten to send R1 to the "mental hospital" if R1 reported the alleged physical abuse occurring to R1. LPA interviewed S1, S2, and S3, who all stated that they did not threaten R1. S1, S2, and S3 stated that there was no physical abuse to report. LPA interviewed R2 and R3 who both stated that they have not felt threatened while residing at the facility.

In regards to allegation #3, LPA interviewed S2 who stated that R1 has requested to move out of the facility on numerous occasions and consented to being placed at R1's current home. LPA interviewed R1, who stated that they are unaware of who and how they were placed into another home. R1 stated that R1 is unaware if an eviction notice was provided to them. LPA asked if R1 consented to being placed into another home, to which R1 could not provide a consistent response. LPA interviewed S1 who confirmed S2's interview statement that R1 requested to be moved into another facility and consented to being moved.

Based on evidence obtained during the investigation, LPA has determined that the above allegations are 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 was discussed and a copy was provided to the Administrator via email.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Stephanie Williams
LICENSING EVALUATOR SIGNATURE:	DATE: 09/13/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/13/2021

LIC9099 (FAS) - (06/04)

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