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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 04:11:50 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
08/05/2020 and conducted by Evaluator Janira Arreola
COMPLAINT CONTROL NUMBER: 18-AS-20200805105818
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:Administrator, Nkechi AnwuliTIME COMPLETED:
04:25 PM
ALLEGATION(S):
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Client was assaulted by another client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, made an unannounced visit to the facility in order to deliver investigation findings on the above allegations. LPA met with Administrator Nkechi Anwuli, who was informed of the purpose of the visit.

On 08/05/2020 the regional office received the complaint and initated an investigation on 08/07/2020. Facility documentation was requests, and interviews were conducted.

LPA found that the facility Grand Villa is an Adult Residential Facility, serving clients between the ages of 18 and 59 years old. It was also found through interview with the Adminisrator that all staff and all residents at the facility are the same gender. Desription of the client being assaulted was a male aged 65 years old. Therefore, LPA was unable to coorobate the allegation due to the description of the client being too vague, and not fitting the description of the other clients in care at the time.
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-20200805105818
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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Therefore, based on LPA observation and records review, the allegation “ Client was assaulted by another client” was found to be unsubstantiated. A finding of unsubstantiated means that the preponderance of the evidence standard has not been met in order to prove that the allegation did occur.

No deficiencies were issued at the time of the visit. An exit interview was conducted where this report was reviewed and provided to Administrator, Nkechi Anwilu.
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