331881164-12-15-2025-18-AS-RORN-DPMMHZ-20251223083822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881164
Report Date: 12/15/2025
Date Signed: 12/15/2025 03:44:19 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
09/10/2024 and conducted by Evaluator Mary G Flores

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240910135215

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:	12/15/2025
		UNANNOUNCED	TIME BEGAN:	11:56 AM
MET WITH:	Cesar Santiago - Direct Support Staff		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility lacks sufficient staffing to meet client's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Flores conducted a subsequent complaint investigation visit regarding the above allegation. LPA met with and explained the reason for the visit.

The investigation consisted of the following: On 9/18/24 LPA Delgado conducted an initial complaint investigation visit. On 12/10/25 LPA Flores contacted Inland Regional Center Facility Liaison, Adult Day Program director, and facility’s administrator over the phone and requested pertaining documents. On 12/11/25 LPA Flores conducted interviews with 4 clients and 2 staff over the phone. On 12/15/25 LPA Flores conducted a subsequent complaint visit, interviewed 2 staff, and delivered findings.

The investigation revealed the following: Regarding allegation: Facility lacks sufficient staffing to meet client’s needs. It is alleged client was not picked up in a timely manner from Day Program due to lack of staff.
(CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025

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-20240910135215

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: 12/15/2025

NARRATIVE

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Interviews with clients revealed clients are picked up timely from appointments or day program. Interviews with staff revealed facility’s protocol is to pick up within 30 minutes. However, clients’ day program is within 30 minutes of the facility and that can become difficult if there are any unforeseen delays. Interview with administrator revealed on 9/10/24, adult day program staff had called staff to request client #1(C1) be picked up. However, staff were with another client at an appointment and there is only one facility vehicle, and the appointment was at a further distance from the facility and day program. While they made arrangements for C1 to be picked up it took them longer to respond. Interview with Day Program staff revealed it was C1’s first day at day program and this was an isolated incident. Per incident report submitted to the Inland Regional Center on 9/11/24, At 9:40am adult day program staff called facility’s staff. Additional contacts were made at 10:19am and 10:30am. C1 began showing self dangerous behavior, adult day program staff sought emergency services assistance. At 11:20am, C1 was taken by emergency personnel and facility’s staff arrived to pick up C1. C1’s Individualize Program Plan dated: 4/30/24 does not note transportation services needed or respond time to prevent C1’s aggressive behaviors. Facility’s plan in place date 2/18/24 does notes staff will assist C1 by removing C1 from behavior trigger and with copying mechanisms. Interview with IRC facility’s liaison revealed a plan to better assist the clients during emergency was developed on 11/19/24. Although, the incident occurred, and facility staff did not pick up C1 within 30 minutes. Facility staff did respond based on the circumstances that surround the care of each client in care. Therefore, this 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.

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

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Mary G Flores
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2025

LIC9099 (FAS) - (06/04)

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