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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800073
Report Date: 07/14/2021
Date Signed: 07/14/2021 02:57:31 PM



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
02/17/2021 and conducted by Evaluator Deborah Mullen
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210217143424
FACILITY NAME:VINEYARD PLACEFACILITY NUMBER:
331800073
ADMINISTRATOR:DAWNIESHA AMAYAFACILITY TYPE:
740
ADDRESS:24325 WASHINGTON AVETELEPHONE:
(951) 387-8410
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:82CENSUS: 58DATE:
07/14/2021
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Arlene Crawford, Executive DirectorTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of supervision resulting in resident being hit by another resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Deborah Mullen and Jesse Gardner delivered the findings of the above allegation. LPA met with Arlene Crawford, Executive Director The investigation involved interviews with staff, Administrator and other witnesses. Resident 1 (R1) was unable to be interviewed due to cognitive impairment.

The allegation stated lack of supervision resulted in resident being hit by another resident. Interviews with the Administrator and staff revealed R1 was involved in an altercation on 1/23/21 and 2/15/21. The incidents took place in the main activity room and neither time did either resident sustain any injuries. Both residents have a diagnosis of Dementia which can result in impulsive behavior. As both incidents took place in the activity room with staff present, the allegation that resident was hit due to a lack of supervision could not be corroborated. Per Adninistrator staff continue to monitor R1 and redirect as appropriate to avoid additional negative interactions.

Based on the information obtained there is not enough evidence to state a lack of supervision resulting in resident being hit by another resident. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report was reviewed with and provided to the Executive Director
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2021
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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