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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881148
Report Date: 03/19/2026
Date Signed: 03/19/2026 11:39:18 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
05/25/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20230525115835
FACILITY NAME:LEVI HOMEFACILITY NUMBER:
331881148
ADMINISTRATOR:GARCIA, JESSEFACILITY TYPE:
735
ADDRESS:73463 GUADALUPE AVENUETELEPHONE:
(760) 600-7020
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:4CENSUS: 4DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
10:04 AM
MET WITH:Julie BaezTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff administered medication to resident without required consent.
Staff billed resident for services not provided.
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 consisted of the following: LPA conducted interviews with the House Manager (HM), three clients (C2- C4), and three staff members (S1-S3). LPA also reviewed these documents: the Client’s Roster, Staff Roster, a copy of (C1)’s face sheet, the Admission Agreement dated 09/22/2022, (C1) Physician’s Report for Community Care Facilities (dated 10/09/2023), and the list of medications from March 21, 2023, through June 24, 2023. The Medication Administration Records (MAR) dated April 21, 2023. Levi Home -Social Activities & Attendance dated April 1, 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)
Page: 1 of 4
Control Number 18-AS-20230525115835
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 #1: Staff administered medication to residents without required consent.

The complaint alleged that the facility administered Risperdal and Invega monthly without the responsible party's knowledge. On March 19, 2026, LPA Richard interviewed the House Manager (HM), who denied the allegation. HM stated that the responsible party and the conservator (RP/C) were aware that these medications were provided to the client by the client’s Physician. HM also mentioned that the RP/C gives consent and was supplied with the medications to administer to the client themselves during the weekends when the client is with them.

On March 19, 2026, LPA interviewed three staff members (S1-S3), all of whom denied the allegation. They confirmed that they followed the doctor's orders when assisting the client with their medications. Additionally, LPA interviewed three clients (C2-C4), all of whom stated that staff members helped them with their medications.

LPA reviewed records from the client's doctor’s order sheet at Parkview Medical Plaza Pharmacy, which indicated that the client's physician prescribed the medications. Furthermore, the Medication Administration Record (MAR) showed that the facility followed the doctor's orders by assisting the client with medication administration.

Report Continued on LIC9099C

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)
Page: 2 of 4
Control Number 18-AS-20230525115835
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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LPA also examined several signed documents dated March 2023, indicating that the RP/C had consented to the facility's assistance with the medications. A review of the unusual incident injury report dated April 25, 2023, revealed that the RP/C signed the medication release form when C1 was going with them on the weekend.

LPA was unable to interview C1, as C1 had moved out of the facility on May 3, 2023. Additionally, LPA attempted to contact the RP/C several times but was unsuccessful.

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.

Allegation #2: Staff billed residents for services not provided.

The complaint alleged that the client representative paid for the client to participate in community activities, but the facility failed to fulfill these commitments. On March 19, 2026, the Licensing Program Analyst (LPA) interviewed the House Manager (HM), who denied the allegation. HM stated that every two weeks, facility staff took the client (C1) horseback riding, as these activities were approved and paid for by the Responsible Party/Conservator (RP/C).

Report Continued On LIC9099C

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)
Page: 3 of 4
Control Number 18-AS-20230525115835
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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During the same visit, the LPA interviewed three staff members (S1-S3), all of whom denied the allegation, asserting that the facility regularly organized outings for clients in the community. The LPA also spoke with three clients (C2-C4), who likewise denied the claim, highlighting that they regularly left the facility to engage in activities such as visiting museums, going to the movies, and going to the beach.

Additionally, on March 19, 2026, the LPA reviewed a signed document dated March 2023 from the RP/C, which provided consent for the facility to take C1 out of the facility for community activities, including horseback riding. The LPA was unable to interview C1, as C1 had moved out of the facility on May 3, 2023. LPA attempted to contact the RP/C multiple times but was unsuccessful.

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. A copy of the report was provided to the House Manager, Julie 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)
Page: 4 of 4