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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880747
Report Date: 11/15/2021
Date Signed: 11/15/2021 03:06:22 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
10/29/2021 and conducted by Evaluator Jesse Gardner
COMPLAINT CONTROL NUMBER: 18-AS-20211029084008
FACILITY NAME:CHIHUAHUA HOMEFACILITY NUMBER:
331880747
ADMINISTRATOR:WEST COAST CARE PROVIDERSFACILITY TYPE:
735
ADDRESS:77595 CALLE CHIHUAHUATELEPHONE:
(442) 256-4174
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:4CENSUS: 4DATE:
11/15/2021
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Shayla Rodriguez, AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are psychologically abusing the residents in care.
Staff are physically abusing the residents in care.
Staff are neglecting the residents in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to conclude this agency's investigation to the above mentioned complaint allegations. LPA spoke with Administrator, Shayla Rodriguez and (R1, R2).

LPA Gardner's investigation which consisted of interviews with facility staff and residents revealed, during an interview with residents (R1 and R2), and combined with interviews that were conducted previously, LPA concluded after statements were made that contridicted eachother. R2 denied that he was ever hit by staff and stated that he's never made to feel abused, emotionally, or physically. R2 doesn't also feel neglected on which the allegation was based upon. Thus, the allegations were deemed to be UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation 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: Reyna Lacey
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2021
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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