331881148-3-19-2026-18-AS-RORN-DSGMF7-20260324093351

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881148
Report Date: 03/19/2026
Date Signed: 03/19/2026 10:02:59 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
01/09/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 18-AS-20230109153708

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: 4	DATE:	03/19/2026
		UNANNOUNCED	TIME BEGAN:	07:56 AM
MET WITH:	Julie Baez		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Lack of care and supervision, in resulted of resident being hit.

INVESTIGATION FINDINGS:

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On March 19, 2026, at approximately 8:00 AM, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent unannounced complaint visit. LPA met the House Manager (HM) Julie Baez, and LPA Richard explained the purpose of this visit.

The investigation included the following: LPA conducted interviews with the House Manager (HM), three staff members (S1-S3), four clients (C1-C4), and the responsible party (RP). LPA reviewed these documents: the Client’s Roster, Staff Roster, a copy of (C1)’s face sheet, the Admission Agreement dated 09/22/2022, (C1)’s Physician’s Report for Community Care Facilities (dated 10/09/2023), the list of medications from May 2023, and the Medication Administration Records (MAR) from May 2023.

Report continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

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-20230109153708

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: 03/19/2026

NARRATIVE

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Allegation: Lack of care and supervision resulted from the resident being hit.

The complaint claimed that inadequate care and supervision resulted in the client having their hair pulled and their neck hit. On March 19, 2026, LPA interviewed the House Manager (HM), who denied the allegation and stated that staff are always nearby when they know clients have behavioral issues. At the same time, LPA interviewed three staff members (S1-S3), all of whom denied the allegation and stated they were always close to, or in the room with, the clients. They also stated that most clients have a one-on-one staff member available at all times. On March 19, 2026, LPA also interviewed three clients (C1-C4) 3 out of 4 denied the allegation and said no one pulled their hair or hit them. LPA interviewed C1; however, C1 denied the allegation, said that the facility treats C1 with care, and refused to answer any further questions. On March 19, 2026, LPA interviewed the responsible person, who refused to be interviewed and stated that Community Care Licensing waited too long to investigate the allegation, as the client no longer resides at the facility. There is no new information to provide.

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.

No deficiencies were cited.

An exit interview was conducted, and a copy of the report was provided to the house manager, July Baez.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 03/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026

LIC9099 (FAS) - (06/04)

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