331880747-3-27-2023-18-AS-JESL-CSD6MA-20230531205537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880747
Report Date: 03/27/2023
Date Signed: 03/27/2023 04:08:04 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
03/21/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230321095000

FACILITY NAME:	CHIHUAHUA HOME		FACILITY NUMBER:	331880747
ADMINISTRATOR:	WEST COAST CARE PROVIDERS		FACILITY TYPE:	735
ADDRESS:	77595 CALLE CHIHUAHUA		TELEPHONE:	(442) 256-4174
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	4	CENSUS: 4	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Rosa Lopez, Caregiver		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff do not prevent a client from wandering while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannouced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA was greeted and granted entry by Caregivers Dora Arreola-Parra and Rosa Lopez. The Administraor was unavailable to come to the facility, but was availabe via telephone. LPA explained the purpose of the visit and elements of the allegation. The investigation consisted of obervation, interview and record review.

Regarding the allegation staff do not prevent client from wandering while in care. Client #1 (C) was admitted to the facility on March 2, 2023. C1 does have a history of elpoing frequently since being placed at the facility. C1 eloped on March 7th, 9th, 11th, 12th, 18th and 19th. Per documentation reviewed C1 has stated that they do not like being at the home and would rather going to live with their homeless friends. The eloping incident on March 19, 2023 C1 was sent to the hosptial as they stated they were not feeling well. Staff #1 and Staff # 2 (S1) and (S2) report that they are not allowed in the room, and that they hopsital called stating that C1 was ready to be released, however C1 leaves unsupervised before staff arrrive at the

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

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-20230321095000

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: CHIHUAHUA HOME	FACILITY NUMBER: 331880747
	VISIT DATE: 03/27/2023

NARRATIVE

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hospital. S2 states that C1 has called 9-1-1 theirself, reporting that they do not feel well. LPA inquired about what C1 does to stay busy throughout the day and S1 stated that an application has been submitted for C1 to attend the day program, however no response have been given yet. As of now C1 will go for walks, watch TV, and sleep throughout the day. Per the administrator the staff follow C1 each time they take off but the staff will get stuck in traffic and C1 will turn down a street and staff lose sight. At this time the plan is to increase C1's medication, no further discussion has been had to assist C1 with their eloping behaviors.

Based on observation interview and record review the allegation of staff do not prevent a client from wandering while in care is 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.

An exit interview was conducted and a copy of this report was provided to Caregiver, Rosa Lopez.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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