331880585-4-24-2023-18-AS-NBRN-CR8VCT-20230425161940

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880585
Report Date: 04/24/2023
Date Signed: 04/24/2023 02:40:07 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
07/24/2020 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200724130142

FACILITY NAME:	COOL MEADOW CARE		FACILITY NUMBER:	331880585
ADMINISTRATOR:	DHAHBI, NADA		FACILITY TYPE:	740
ADDRESS:	29787 COOL MEADOW DR		TELEPHONE:	(951) 246-0214
CITY:	MENIFEE	STATE: CA	ZIP CODE:	92587
CAPACITY:	6	CENSUS: 6	DATE:	04/24/2023
		UNANNOUNCED	TIME BEGAN:	09:37 AM
MET WITH:	John Zhang - Licensee		TIME COMPLETED:	02:43 PM

ALLEGATION(S):

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Resident is being neglected and emotionally abused.
Resident made to sit in feces for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Anna Bueno conducted a subsequent unannounced visit to the facility to continue the complaint investigation and deliver findings on the above allegations. LPA met with staff Liz Baclagan who was informed of the purpose of today’s visit. Licensee John Zhang and Administrator Satchel Lecita arrived during the visit. The investigation consisted of staff and resident interviews and review of relevant records.

The allegations are that 1: Resident (R1) is being neglected and emotionally abused; and 2: R1 made to sit in feces for an extended period of time. Resident interview revealed that they lived at the facility for less than a month. Resident did not provide additional information regarding the allegations. Witness interviewed was not able to provide information related to these allegations. Staff interviews do not recall R1 at all while Administrator confirmed that R1 was at the facility for up to two weeks. Administrator further stated that R1 will often call for emergency assistance and local law enforcement visit this facility regularly during R1's residence. Administrator further stated that law enforcement was invited inside the facility each time and staff were told

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

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-20200724130142

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: COOL MEADOW CARE	FACILITY NUMBER: 331880585
	VISIT DATE: 04/24/2023

NARRATIVE

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by law enforcement that a report was not needed after each visit.

Based on the information obtained during this investigation, the above allegations are therefore unsubstantiated. A finding that the allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report was discussed and provided to Licensee.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Anna Bueno	TELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2023

LIC9099 (FAS) - (06/04)

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