331800484-9-20-2023-18-AS-JDHS-CWPMNQ-20231017094551

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800484
Report Date: 09/20/2023
Date Signed: 09/20/2023 12:48:40 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
09/16/2021 and conducted by Evaluator Yolanda Delgado

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210916143211

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:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	12:05 PM
MET WITH:	Paulina Corona, Administrator		TIME COMPLETED:	12:50 PM

ALLEGATION(S):

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Staff pushed resident.
Staff does not safeguard resident food.
Medication not being administered as prescribed.
Staff locked resident in their room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Yolanda Delgado, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Administrator, Paulina Corona, and informed her of the purpose for her visit.

Regarding the allegation, "Staff pushed resident.," it was alleged Staff One (S1) pushed Resident One (R1). Staff/resident interviews were conducted, Regarding the allegation “Staff does not safeguard resident food”, it was alleged unnamed staff eat R1’s food. Staff/resident interviews were conducted, regarding allegation “Medication not being administered as prescribed”, it was alleged that staff was observed over medicate residents to get them to calm down. (CONTINUED ON PAGE 2, LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20210916143211

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: VIA GENOA	FACILITY NUMBER: 331800484
	VISIT DATE: 09/20/2023

NARRATIVE

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CONTINUED FROM LIC 9099)

Staff/resident interviews were conducted and regarding allegation “Staff locked resident in their room”, it was alleged that R1 was being locked in their room. Staff /resident interviews were conducted. Staff would need to secure the food from R1 so R1 would not over eat the items provided by family. S1 was interviewed and denied the allegation. Staff denied overmedicating residents. Staff denied allegation of locking R1 in room, residents were taken to their rooms for their safety when another resident would have a behavioral episode at the home while other residents were present. Therefore, due to insufficient information, these allegations is deemed UNSUBSTANTIATED. A finding the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations occurred. This report was reviewed with Paulina Corona, and a copy was provided.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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