331881164-11-21-2025-18-AS-RORN-DQYLJ3-20260204074712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881164
Report Date: 11/21/2025
Date Signed: 11/21/2025 02:50:36 PM

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
12/18/2023 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 18-AS-20231218154407

FACILITY NAME:	RUBIO HOME		FACILITY NUMBER:	331881164
ADMINISTRATOR:	RODRIGUEZ, SHAYLA		FACILITY TYPE:	735
ADDRESS:	51800 AVENIDA RUBIO		TELEPHONE:	(760) 972-4194
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	4	CENSUS: 4	DATE:	11/21/2025
		UNANNOUNCED	TIME BEGAN:	01:22 PM
MET WITH:	Rosa Lopez, Assistant Administrator		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff did not pick up resident from a health facility in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced subsequent complaint visit related to the above allegation. Upon arrival, the LPA met with facility staff and explained the reason for the visit. Assistant Administrator Rosa Lopez arrived at 01:28PM. Entrance interview conducted.

During an initial complaint visit conducted on 12/26/2023, LPA Janette Romero toured the facility and requested copies of pertinent documentation. During today's visit, LPA Dulek interviewed staff at 01:22PM, Assistant Administrator at 01:28PM, reviewed and obtained copies of relevant documents, interviewed Client #1 (C1) at 02:02PM, and conducted a telephonic interview with the Administrator at 02:08PM. Throughout the visit, LPA observed all four (4) clients. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025

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-20231218154407

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: RUBIO HOME	FACILITY NUMBER: 331881164
	VISIT DATE: 11/21/2025

NARRATIVE

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The complaint alleges C1 was ready for discharge from a health facility and facility staff did not pick up C1 until hours later. Record review revealed that C1 moved into the facility on 11/20/2023. Interview and record review revealed that for about a month, C1 was engaging in unwanted behaviors and required medication adjustments. C1 was taken on a 5150 hold on 12/14/2023 at approximately 08:00AM. Interview revealed that C1's family was considering alternate placement at a higher level of care and had requested the facility staff not pick C1 up right away. At that time, they set up a meeting for C1's family, mental health team, and the facility staff to determine the appropriate plan for C1 going forward. Following discussion with the team, it was decided that C1 could return to the home. Documents reviewed revealed C1 was ready for discharge on 12/17/2023, however, no time of contact was listed on the discharge documents. Administrator could not recall the time a telephone call was received and stated the only delay was related to the family's request. Facility notes reviewed revealed that C1 returned to the home at some point between 11:00PM on 12/17/2023 and 06:00AM on 12/18/2023. Interview with C1 revealed facility staff do pick up when needed and C1 always receives prompt attention and pick up when requested. The information obtained during the investigation did not include sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:	DATE: 11/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2025

LIC9099 (FAS) - (06/04)

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