331800484-4-11-2023-18-AS-KCLS-CR2T2U-20230419142115

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800484
Report Date: 06/08/2021
Date Signed: 04/11/2023 11:57:06 AM

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
06/07/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210607090221

FACILITY NAME:	VIA GENOA		FACILITY NUMBER:	331800484
ADMINISTRATOR:	EDGINGTON, JOHN T		FACILITY TYPE:	735
ADDRESS:	47018 VIA GENOA		TELEPHONE:	(760) 262-5957
CITY:	INDIO	STATE: CA	ZIP CODE:	92201
CAPACITY:	4	CENSUS: 4	DATE:	06/08/2021
		UNANNOUNCED	TIME BEGAN:	01:35 PM
MET WITH:	Nicole Lara, DSP		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Allegation 1: Staff caused injury to client
Allegation 2: Staff grabbed resident in a rough manner
Allegation 4:Staff punished resident with cold baths

INVESTIGATION FINDINGS:

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**This is a copy of Original 9099 dated 6/08/2021, investigation conducted by LPA Shaunte Henry and Anna Bueno**
On 6/8/21 Licensing Program Analysts (LPA) Shaunte Henry and Anna Bueno conducted an unannounced visit to initiate an investigation into the above allegations. LPAs spoke to DSP Nicole Lara, explained the purpose of the visit, and were granted entry. The investigation, which consisted of interviews and document review revealed the following:
Allegation 1: Staff caused injury to client: Client 2 (C2) had a behavior episode and scratched Client 1 (C1). This was confirmed by interviews and an unusual incident report that faxed to CCL regarding the incident.
Allegation 2: Staff grabbed resident in a rough manner: During the same behavior episode, C2, grabbed C1 in a rough manner, not staff. Allegation 4: Staff punished resident with cold baths:The client and staff interviews revealed that no one witnessed staff or had knowledge of staff giving C1 a cold bath therefore based on the investigation findings the above allegation.
Based on the investigation, the above finding is Unsubstantiated. A finding of unsubstantiated means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2021

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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