331881164-9-5-2023-18-AS-JDHS-CW58RU-20230928224516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881164
Report Date: 09/05/2023
Date Signed: 09/05/2023 03:37:23 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/05/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230605121812

FACILITY NAME:	RUBIO HOME		FACILITY NUMBER:	331881164
ADMINISTRATOR:	RODRIGUEZ, SHAYLA		FACILITY TYPE:	735
ADDRESS:	51800 AVENIDA RUBIO		TELEPHONE:	(909) 659-7404
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	4	CENSUS: 3	DATE:	09/05/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Vincente Ortiz, DSP		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is retaining a resident that requires a higher level of care
Staff do not provide a safe environment for resident's in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation(s) noted above. LPA met with Vincente Ortiz, Direct Support Professional (DSP I) and explained the purpose of the visit.

Regarding the allegation of facility is retaining a resident that requires a higher level of care.

Resident #1 (R1) was admitted to the facility on 11/29/22. Upon admission R1 was reported to be calm, with no presenting behaviors, and around May 2023 R1 began to exhibit aggressive, and defiant behaviors. Per record review R1 had a change in their medication, and due to hospitalizations, they were not taking their medication on a consistent basis, and that they were not on the medication long enough to be stabilized as there was either an increase or a decrease in the dosages. Interviews conducted with multiple staff, revealed that with the training including crisis intervention, that they were not equipped to *** Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

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 18-AS-20230605121812

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: RUBIO HOME	FACILITY NUMBER: 331881164
	VISIT DATE: 09/05/2023

NARRATIVE

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handle R1. The facility is defined by the placing agency as a Specialized 113 Home, the home is between a level 4I and an Enhanced Behavioral Support Home EBSH. Interviews with staff revealed that staff felt that they were not trained to handle the behaviors but not that R1 require a higher level of care. Based on interviews and record review the allegation of facility is retaining a resident that requires a higher level of care is UNSUBSTANTIATED.

Staff do not provide a safe environment for resident's in care.

Per interviews with staff revealed that it is unpredictable when Residents are going to have a behavior, however it is something to be expected. The first priority is to ensure that the residents are safe. There is a plan in place to clear the area, by sending any other residents to their rooms, if that if not an option, then the residents are redirected outside. If the behavior is extreme then the other residents are taken for a drive, grab a meal and or to the sister facility as a distraction. Lastly, contacting law enforcement is contacted when the resident's behavior becomes combative. Per an interview with Resident # 1 and #2 (R1) and (R2), R1 state that staff do make them feel safe. R2 states that they have been taken off grounds when other residents are having a big behavior. The facility does not have a written safety plan, however could verbally tell what is done to ensure the residents are in a safe environment. Based on observation and interviews the allegation of staff do not provide a safe environment for resident's in care is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted and a copy of this report was provided to Vincent Ortiz, DSP.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 09/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/05/2023

LIC9099 (FAS) - (06/04)

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