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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800157
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:14:53 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
03/24/2020 and conducted by Evaluator Janira Arreola
COMPLAINT CONTROL NUMBER: 18-AS-20200324132235
FACILITY NAME:GRACE VILLAFACILITY NUMBER:
331800157
ADMINISTRATOR:ANWULI, NKECHIFACILITY TYPE:
735
ADDRESS:22699 KINROSS LANETELEPHONE:
(951) 704-3741
CITY:MORENO VALLEYSTATE: CAZIP CODE:
92557
CAPACITY:6CENSUS: 4DATE:
09/19/2022
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Administrtaor, Nkechi AnwuliTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Facility staff hit resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unnounced visit in order to deliver investigation findings concerning the above allegation. LPA met with Administrator, Nkechi Anwuli, who was informed of the purpose of the visit.

The regional office received the complaint on 3/24/2020 and initiated an investigation on 4/1/2020. Faciltiy records and interviews regarding the above allegation were collected.

The complaint consisted of Staff 1 (S1) hitting Client 1 (C1) on 3/20/2020. The department received conflicting information from C1 and facility incident report. Per facility incident report and interview of regional center representative, C1 admitted to fabricating the incident. Past incident reports, as well as client IPP revealed that C1 had a history of fabricating stories and calling 911 in non-emergency situations.

One such incident report dated on 3/23/2020, stated staff overheard C1 tell their caseworker that staff had hit them. When asked, C1 stated that they was referring to the incident on 3/20/2020 where they had admitted to police and facility administrator they had fabricated the incident.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022
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-20200324132235
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: GRACE VILLA
FACILITY NUMBER: 331800157
VISIT DATE: 09/19/2022
NARRATIVE
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Due to interviews, record review, and LPA observation, there was no evidence to suggest that C1 had been hit by S1. Therefore, it is found that the allegation is unsubstantiated. A finding of unsubstantiated means that the preponderance of the evidence standard has not been met in order to state that the allegation did occur.

No deficiencies were issued at the time of the visit. An exit interview was conducted were a copy of this report was reviewed and provided to Administrator, Nkechi Anwuli.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2