331880747-4-6-2023-18-AS-JESL-CSD68Q-20230531203530

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880747
Report Date: 04/06/2023
Date Signed: 04/06/2023 04:07:56 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
04/04/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230404121844

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: 3	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	10:02 AM
MET WITH:	Shayla Rodriguez, Adminstrator		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff locks resident out of the facility.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licenisng Program Analyst (LPA) Javina George made an unnannounced visit to the facility to commence a complaint investigation reagrding the allegation listed above. LPA met with Administrator Shayla Rodriguez and explained the purpose of the visit. The allegation staff locks resident out of the facility was investigated.
The investigation consisted on observation, interviews and record review.

Regarding the allegation of staff locks resident out of the facility. Client #1 (C1) has left the facility an estimated forty times, as they leave two (2) times in a single day, since they were placed at the facility on March 2, 2023. C1 has stated that they do not want to be at the facility and would rather be with the homeless indivduals in the community. Interviews conducted revealed that C1 will call 9-1-1 their self, will be transported via ambulance and will be discharged shortly after their arrival as there is usually nothing wrong. A call is made to the facility to come and pick up C1. Per the Administrator and staff interviews the staff leave right away. The facility is approximately 25 minutes away from the hospital, and by the time staff arrive C1 is already gone. Additional feedback provided was that C1 was brought back to the facility via taxi a

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 18-AS-20230404121844

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: 04/06/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

couple of weeks ago. Per Administrator Shayla the facility doors are locked during the Noc/overnight shift 12am-5:30am, and this is done as a security measure. However at no time do staff recall refusing to let C1 in the facility doors.

Additionally, LPA reviewed documentation on April 1, 2023 when C1 was ready to be discharged after having been sent out to the hospital, and the staff communicated the pick up and left immediately. Therefore, the allegation of staff locks the resident out of the facility 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 the Administrator Shayla Rodriguez.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2