331880768-1-10-2025-18-AS-JDHS-DCZVBT-20250117151801

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880768
Report Date: 01/10/2025
Date Signed: 01/10/2025 04:05:17 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
12/17/2024 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20241217141415

FACILITY NAME:	PINE CREEK CARE SERVICES		FACILITY NUMBER:	331880768
ADMINISTRATOR:	DAVIS, CHRIS		FACILITY TYPE:	735
ADDRESS:	38203 PINE CREEK PLACE		TELEPHONE:	(951) 319-6374
CITY:	MURRIETA	STATE: CA	ZIP CODE:	92562
CAPACITY:	4	CENSUS: 2	DATE:	01/10/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Licensee, Chris Davis		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facilty Staff physically abused resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Licensee/Administrator, Chris Davis, and explained the purpose of the visit and the elements of the allegation. The investigation consisted of observations, interviews with staff members and residents, and a review of records.

On December 17, 2024, Community Care Licensing received a complaint alleging that facility staff physically abused a resident while in care. It was alleged that an incident occurred at the facility in which the Administrator tried to prevent Resident 1 (R1) from leaving the facility. During the process of trying to leave without permission (AWOL), it was alleged that Administrator pushed R1 aggressively to prevent R1 from leaving. Information obtained from Administrator stated that he has never physically tried to prevent R1 from leaving the facility and denies physically abusing any residents in care. Administrator also denies that any staff members were physically abusive toward any residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

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-20241217141415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: PINE CREEK CARE SERVICES	FACILITY NUMBER: 331880768
	VISIT DATE: 01/10/2025

NARRATIVE

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LPA interviewed residents, who indicated they have never been physically abused at the facility. Information obtained from residents indicated they did not have issues of concerns regarding treatment at the facility. LPA interviewed staff members who advised they treat all residents care according to their personal rights. Staff members denied any allegations of physical abuse occurring at the facility. Staff members were able to explain to LPA the protocol when a resident attempts to AWOL.

LPA was unable to interview R1 regarding the incident due to R1 being incarcerated. During the course of the investigation, LPA was also unable to reach additional pertinent parties.

Based on the information obtained during the investigation and due to LPA unable to interview all pertinent parties, the allegation that staff physically abused residents while in care is unsubstantiated. Although the allegations may have occurred or may be valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated at this time.

An exit interview was conducted, and a copy of this report was discussed with and provided to Administrator, Chris Davis.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2025

LIC9099 (FAS) - (06/04)

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