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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603484
Report Date: 08/30/2024
Date Signed: 08/30/2024 04:01:46 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/10/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240410160459
FACILITY NAME:CANYON RIMFACILITY NUMBER:
198603484
ADMINISTRATOR:EVE, AUCIONE COELHOFACILITY TYPE:
735
ADDRESS:6512 BEQUETTE AVETELEPHONE:
(562) 395-8118
CITY:PICO RIVERASTATE: CAZIP CODE:
90660
CAPACITY:4CENSUS: 4DATE:
08/30/2024
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Carolina Ramirez, StaffTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Client sustained an unexplained injury while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegation listed above. LPA arrived unannounced and met with Staff, Carolina Ramirez. The purpose of the visit was explained. Administrator, Aucione Eve, arrived shortly after to assist.

The investigation consisted of the following:
On 4/15/24, LPA Irra obtained a copy of the staff and client rosters. LPA reviewed the file for Client #1 (C-1) and obtained relevant documentation. LPA was unable to interview Client #1 (C-1) through Client #4 (C-4) as all clients were not home at the time of this visit. LPA interviewed the administrator.
During the visit today, LPA Chan interviewed additional staff and 3 Clients.

(continue on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
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 28-AS-20240410160459
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: CANYON RIM
FACILITY NUMBER: 198603484
VISIT DATE: 08/30/2024
NARRATIVE
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The investigation revealed the following:

Allegation - Client sustained an unexplained injury while in care. It was alleged that Client #1 (C-1) had a scratch/bruise on the back, which looked like fingers or handprint. LPA reviewed documents and interviewed staff and clients to determine findings. It was reported that the injury was discovered on 4/1/24. One of the staff on duty that morning did not observe any marks on C-1’s back. The facility notes for C-1 did not indicate any injuries during the morning hours on 4/1/24 nor any days prior. However, it was noted the mark was observed after returning from the day program on 4/1/24.

Staff interviewed stated they have not observed any type of abuse at the home. Staff stated they conduct body checks daily and briefly note any activities for each client. 3 out of the 3 clients interviewed enjoy living at the facility and stated staff treat them good. They have not seen any staff hit or grab a client. Based on interviews and record review, there is insufficient evidence to prove the injury occurred at the facility.

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, therefore the allegation is UNSUBSTANTIATED.



An exit interview was conducted with the administrator. A copy of this report along with the appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2024
LIC9099 (FAS) - (06/04)
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