331881148-10-8-2025-18-AS-RORN-DMNMTR-20251021095356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881148
Report Date: 10/08/2025
Date Signed: 10/08/2025 10:54:48 AM

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
10/07/2022 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221007163010

FACILITY NAME:	LEVI HOME		FACILITY NUMBER:	331881148
ADMINISTRATOR:	GARCIA, JESSE		FACILITY TYPE:	735
ADDRESS:	73463 GUADALUPE AVENUE		TELEPHONE:	(760) 600-7020
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	4	CENSUS: 3	DATE:	10/08/2025
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Julie Baez - House Manager		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Client spit on another client in care.
Staff are forcing client on family visits.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted an unannounced subsequent complaint visit regarding the above allegations. LPA met with Julie Baez and explained the reason for the visit.

The investigation consisted of the following: On 10/14/22 LPA Gardner conducted an initial complaint investigation visit. On 10/4/23 LPA Delgado requested sheriff’s department report and interviewed 2 staff over the phone. On 10/2/25 LPA Flores contacted facility’s administrator and requested the following documents for client #1(C1); physician’s report, admission agreement, IPP, needs and care plan, notes, incident reports and interviewed 3 staff over the phone. On 10/6/25 LPA Flores interviewed 2 staff and 3 clients over the phone. On 10/7/25 LPA Flores requested copies of documents and delivered findings.

The investigation revealed the following: Regarding allegation: Client spit on another client in care. It is alleged client #2(C2) spit at C1 while in the dining room.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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-20221007163010

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: LEVI HOME	FACILITY NUMBER: 331881148
	VISIT DATE: 10/08/2025

NARRATIVE

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Interviews conducted with clients revealed staff are available and around clients always, and clients have not shown aggressive or disrespectful behaviors. One client stated that C2 bit C1 in the arm on one occasion and not spit. Interviews with staff revealed staff are present and when they observe a behavior that can harm other clients or self. Per staff when a client is having a behavior, they ask the clients to go to their rooms to keep them away from the client having a behavior and safe. The home is a specialist living home in which some clients may have aggressive behaviors and a one-on-one staff to assist. LPA Delgado was not able to obtained a copy of sheriff’s department report. Inland Regional Center conducted an investigation during the time of the incident and substantiated the allegation. Although the incident may have happened per interviews conducted there is no preponderance of evidence C2 spit at C1. Therefore, the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Regarding allegation: Staff are forcing client on family visits. It is alleged facility staff is forcing resident to go to family visits. Interviews with clients revealed clients personal rights are respected by staff and have not been forced to go on visits. Interviews with staff revealed clients are assisted with visits, since there may be visits that are far from the facility they assist to drive the clients half way to meet their responsible parties and be picked. Staff also stated to respect the desire not to go on a visit as it is their personal right.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

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