331880819-2-21-2024-18-AS-TDAN-D4U6ZD-20240430211457

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880819
Report Date: 02/21/2024
Date Signed: 02/21/2024 12:56:10 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
02/14/2024 and conducted by Evaluator Crystal Colvin

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240214164847

FACILITY NAME:	CALEB HOME		FACILITY NUMBER:	331880819
ADMINISTRATOR:	SAMANTHA PADILLA		FACILITY TYPE:	735
ADDRESS:	49252 PLUMA VERDE PLACE		TELEPHONE:	(760) 601-7307
CITY:	COACHELLA	STATE: CA	ZIP CODE:	92236
CAPACITY:	4	CENSUS: 4	DATE:	02/21/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Stephanie Olivas - Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not providing appropriate care and supervision to the residents resulting in facility having to unnecessarily call 911.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Crystal Colvin conducted an unannounced visit to the facility for the purpose of conducting a complaint investigation for the above allegation. LPA Colvin met with Administrator Stephanie Olivas and advised her of the purpose of today's inspection. Below is a summary of the investigation.

Regarding allegation "Staff are not providing appropriate care and supervision to the residents resulting in facility having to unnecessarily call 911": LPA Colvin interviewed Resident One (R1), staff, other persons responsible/knowledgeable of R1's care and reviewed relevant facility records. LPA Colvin observed that R1 has a Behavioral Support Plan in place regarding their behaviors, such as self-injurious behaviors, with directions on how facility staff are to respond and address these behaviors. Interviews with staff and Consumer Notes both support that staff are following R1's Behavioral Support Plan, which includes redirecting R1 to another activity as well as talking with R1 regarding their emotions and behaviors to try to provide additional assistance.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

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-20240214164847

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: CALEB HOME	FACILITY NUMBER: 331880819
	VISIT DATE: 02/21/2024

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

LPA Colvin additionally observed that in a review of a sample of R1's Consumer Notes for the month of February 2024, R1 had 15 documented behavioral episodes. Out of these 15 episodes, 911 emergency services were only called out to the facility by staff 3 times, and the Riverside County Mental Health Mobile Crisis Line was called 3 times. LPA Colvin questioned staff about under what circumstances they contact 911 for R1's behaviors, and in these interviews, staff relayed that 911 is only contacted if their efforts to redirect R1 are unsuccessful, and R1's self-injurious behaviors are extreme enough that they are worried about R1's physical well-being. An example of this was provided by multiple staff members wherein R1 was bleeding from their head after banging their head repeatedly.

Since interviews and other facility records support the assertion that staff are following the provided Behavioral Support Plan for R1 and other persons interviewed by LPA Colvin who are responsible for oversight of R1's care additionally confirmed that facility staff are following correct procedure, the allegation "Staff are not providing appropriate care and supervision to the residents resulting in facility having to unnecessarily call 911." is UNSUBSTANTIATED.

A finding of UNSUBSTANTIATED means 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 with Administrator Stephanie Olivas and a copy of this report was provided.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Crystal Colvin
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2