331880932-9-20-2023-56-AS-EMAN-CVUV2T-20230920160340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880932
Report Date: 09/20/2023
Date Signed: 09/20/2023 11:47:48 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
05/18/2022 and conducted by Evaluator Ryan Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220518161343

FACILITY NAME:	DAWSON HOMES INC. ON JEANNIE ANN CIRCLE		FACILITY NUMBER:	331880932
ADMINISTRATOR:	HAWTHORNE, ADINA		FACILITY TYPE:	735
ADDRESS:	7889 JEANNIE ANN CR.		TELEPHONE:	(951) 898-7692
CITY:	CORONA	STATE: CA	ZIP CODE:	92880
CAPACITY:	4	CENSUS: 4	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	10:55 AM
MET WITH:	Adina Hawthrone- Administrator		TIME COMPLETED:	11:56 AM

ALLEGATION(S):

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Staff engaged in a verbal altercation with resident.
Staff called resident an inappropriate name.
Staff threatened resident.
Facility toilet is unsanitary.
Staff encouraged resident to use an unsanitary toilet.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ryan Gardner made an unannounced visit to deliver findings for the allegations listed above. LPA stated the purpose of the visit and was granted entry and met with Administrator Adina Hawthrone.

The investigation consisted of interviews with staff, interviews with clients, and facility document review.

For allegation, Staff engaged in a verbal altercation with resident:

Interviews with the clients and interviews with the staff revealed that the clients and the staff both denied that there was verbal altercation between Client C1 and Staff S1. The staff denied having any verbal altercations with the clients. Interviews with the clients revealed that the staff do not engage in verbal altercations with the clients, and they are spoken to in an appropriate manner.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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-20220518161343

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: DAWSON HOMES INC. ON JEANNIE ANN CIRCLE	FACILITY NUMBER: 331880932
	VISIT DATE: 09/20/2023

NARRATIVE

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For allegation, Staff called resident an inappropriate name:

Interviews with the clients and interviews with the staff revealed that the clients and the staff both denied that S1 called C1 an inappropriate name. The staff denied calling any of the client’s inappropriate names. Interviews with the clients revealed that the staff do not call them inappropriate names.

For allegation, Staff threatened resident:

Interviews with the clients and interviews with the staff revealed that the clients and the staff both denied that S1 threatened C1. The staff denied threatening any of the clients. Interviews with the clients revealed that the staff have not threatened the clients.

For allegation, Facility toilet is unsanitary:

Interviews with the clients and interviews with the staff revealed that Client C3 had bowel movement accident and left some fecal matter on the toilet seat. After C3 was done using the bathroom, S1 noticed the fecal matter on the toilet seat. S1 requested the clients to exit the bathroom for a couple minutes so the toilet seat could be cleaned. S1 cleaned the toilet seat once the clients exited the bathroom. Interviews with staff revealed that the bathroom and toilet are cleaned and sanitized once a shift, as well as needed if there are accidents during the day. LPA toured the bathroom on 9/8/2023 and found that the toilet and toilet seat appeared clean with no fecal matter present.

For allegation, Staff encouraged resident to use an unsanitary toilet.

Interviews with the clients and interviews with the staff revealed that the clients and staff both denied that S1 encouraged C1 to use an unsanitary toilet. S1 requested C1 to exit the bathroom for a few minutes so a dirty toilet seat could be cleaned. C1 made their own personal choice to stay in the bathroom with the dirty toilet seat. It is unknown if C1 sat on and or used the dirty toilet seat. The toilet seat was cleaned and sanitized once C1 exited the bathroom. The staff denied that they encouraged any clients to use an unsanitary toilet.

Overall, there was not enough evidence to collaborate the allegations listed above. Based on evidence obtained during the investigation, the five (5) allegations listed above are deemed UNSUBSTANTIATED.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 56-AS-20220518161343

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: DAWSON HOMES INC. ON JEANNIE ANN CIRCLE	FACILITY NUMBER: 331880932
	VISIT DATE: 09/20/2023

NARRATIVE

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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 (LIC9099) was discussed and provided to Administrator Adina Hawthrone, along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Ryan Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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