331800157-9-19-2022-18-AS-JESL-CJPTXB-20220928150652

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800157
Report Date: 09/19/2022
Date Signed: 09/19/2022 04:13:51 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
07/02/2020 and conducted by Evaluator Janira Arreola

COMPLAINT CONTROL NUMBER: 18-AS-20200702121707

FACILITY NAME:	GRACE VILLA		FACILITY NUMBER:	331800157
ADMINISTRATOR:	ANWULI, NKECHI		FACILITY TYPE:	735
ADDRESS:	22699 KINROSS LANE		TELEPHONE:	(951) 704-3741
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92557
CAPACITY:	6	CENSUS: 4	DATE:	09/19/2022
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Administrator, Nkechi Anwuli		TIME COMPLETED:	04:25 PM

ALLEGATION(S):

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Staff caused an injury to a client while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit to the facility in order to deliver finding on the above allegation. LPA Arreola met with Administrator, Nkechi Anwuli who was informed of the purpose of the visit.

On 07/02/2020, the regional office received a complaint that Client 1 (C1), had light bruising and was suspected of being in an altercation with staff at the facility. The department conducted an investigation on 7/10/2020, gathered facility documentation, and conducted interviews.

Interviews with C1 and staff at the facility releaved that C1 had called 911 on the day of the incident after being redirected by staff. Based on the incident reports submitted by the facility, the C1 had told parademics they were having chest pains. Staff interviewed revealed that C1 came back from the hospital apologizing to staff for making false allegations. Staff interviews supported the claim that there was no altercation between staff and C1. Additionaly, Client interviews corroborated this information stating there was no alteraction that took place.

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)

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Control Number 18-AS-20200702121707

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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There were also no incident reports to suggest that C1 had been in an altercation around the time of the incident. C1 has a history of calling 911 in non-emergency situations and has a history of fabricating stories. This was evidenced by staff interviews, client daily notes and quarterly behavior report.

Based on the information reviewed LPA was unable to find evidence to support the allegation and unable to find sufficient information to dismiss the allegation.

Based on LPA observation, interviews, and records review, the above allegation of “Staff caused injury to client while in care” is unsubstantiated. A finding of unsubstantiated means that the preponderance of the evidence standard has not been met in order to suggest that the allegation did occur.

No deficiencies were issued at the time of the visit. An exit interview was conducted were 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)

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