331880821-6-8-2023-56-AS-EMAN-CT6SDD-20230626134657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880821
Report Date: 06/08/2023
Date Signed: 06/08/2023 11:55:11 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/01/2023 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230501141221

FACILITY NAME:	DION HOME 2		FACILITY NUMBER:	331880821
ADMINISTRATOR:	OWENS, OMORODION		FACILITY TYPE:	735
ADDRESS:	22905 PAVLA CT		TELEPHONE:	(714) 392-1860
CITY:	WILDOMAR	STATE: CA	ZIP CODE:	92595
CAPACITY:	4	CENSUS: 3	DATE:	06/08/2023
		UNANNOUNCED	TIME BEGAN:	11:12 AM
MET WITH:	Omorodion Owens- Administrator		TIME COMPLETED:	12:04 PM

ALLEGATION(S):

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Staff slapped an item out of resident's hand.
Staff yelled at resident.
Staff called resident an inappropriate name.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner conducted an unannounced visit to the facility to deliver findings for the above complaint allegations. LPA met with Administrator Omorodion Owens and explained the reason for the visit.

The investigation consisted of interviews with staff, interviews with residents, and review of the facility roster.

For allegation, Staff slapped an item out of resident's hand:

During interviews with staff, the staff denied slapping an item out of a resident's hand. Staff stated they never slap the residents. When LPA inquired about the staff that was accused of slapping the resident, LPA was informed that the listed accuser does not work at the facility.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

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 56-AS-20230501141221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DION HOME 2	FACILITY NUMBER: 331880821
	VISIT DATE: 06/08/2023

NARRATIVE

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During document review, LPA reviewed the facilities staff roster. LPA discovered that staff accused of slapping the resident is not listed on the staff roster.

During interviews with residents, the residents stated that they have not been slapped by a staff member. When LPA inquired about the staff that was accused of slapping the resident, the resident’s stated they did not know a staff by the listed name.

For allegation, Staff yelled at resident:

During interviews with staff, the staff denied yelling at the residents. When LPA inquired about the staff that was accused of yelling at the resident, LPA was informed that the listed accuser does not work at the facility.

During document review, LPA reviewed the facilities staff roster. LPA discovered that staff accused of yelling at the resident is not listed on the staff roster.

During interviews with residents, the residents denied being yelled at by the staff. The residents stated they like the staff and they are treated very well. When LPA inquired about the staff that was accused of yelling at the resident, the resident’s stated they did not know a staff by the listed name.

For allegation, Staff called resident an inappropriate name:

During interviews with staff, the staff denied calling the residents inappropriate names. When LPA inquired about the staff that was accused of calling the resident inappropriate names, LPA was informed that the listed accuser does not work at the facility.

During document review, LPA reviewed the facilities staff roster. LPA discovered that staff accused of calling the resident inappropriate names is not listed on the staff roster.

During interviews with residents, the residents denied being called inappropriate names by staff. When LPA inquired about the staff that was accused of calling the resident inappropriate names, the resident’s stated they did not know a staff by the listed name.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20230501141221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: DION HOME 2	FACILITY NUMBER: 331880821
	VISIT DATE: 06/08/2023

NARRATIVE

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Based on evidence obtained during the investigation, the three (3) allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Administrator Omorodion Owens, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 06/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/08/2023

LIC9099 (FAS) - (06/04)

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