331881373-1-3-2024-18-AS-RSTS-CZE2HA-20240111162426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881373
Report Date: 01/03/2024
Date Signed: 01/03/2024 08:49:14 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
11/30/2023 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231130143231

FACILITY NAME:	COTTON VILLA RCFE		FACILITY NUMBER:	331881373
ADMINISTRATOR:	MESROPYAN, ANAHIT		FACILITY TYPE:	740
ADDRESS:	64982 COTTON CT		TELEPHONE:	(818) 807-1338
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY:	6	CENSUS: 0	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	08:02 AM
MET WITH:	Anahit Mesropyan, Licensee/Adminitrator		TIME COMPLETED:	08:55 AM

ALLEGATION(S):

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Staff handled resident in a rough manner, resulting in an injury.
Staff threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Licensee/Adminitrator Anahit Mesropyan, and informed them of the purpose of this visit. LPA then toured the facility. During this investigation, the Department conducted interviews with staff and clients; obtained supportive documentation for review to assist with determining the findings for the above noted allegations. The following was determined.

Allegation# 1 - Staff handled resident in a rough manner, resulting in an injury. Concerns were expressed that Resident One (R1) had sustained a skin tear on their arm, and that staff (who spoke through a phone application translator) allegedly admitted to causing the skin tear by using force to get R1 to wash their hands.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20231130143231

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: COTTON VILLA RCFE	FACILITY NUMBER: 331881373
	VISIT DATE: 01/03/2024

NARRATIVE

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The Department’s investigation consisted of staff, resident, and witness interviews.

Interview with R1 was attempted, but due to cognitive state, LPA was not able to retrieve much relative information. However, R1 revealed that they weren’t sure if anything happened to their arm, but that staff are nice and take care of them.

A Witness interview stated that they saw Staff One (S1) with R1 in relation to the incident, and that it did not appear as if staff was “forcing” R1 to wash their hands, only that staff was assisting R1 with a bandage after sustaining an injury. Witness interview further stated that they believed that R1 could have sustained the injury due to R1 constantly scratching their head, neck and arms. Based on witness and staff statements of the incident, the allegation was Unsubstantiated.

Allegation #2 – Staff threatened resident. The allegation received stated a caregiver told R1 that the caregiver would break R1’s arm if R1 went into the refrigerator for food. The statement provided further alleged that the threat was read out loud by R1 to the caregiver after the caregiver utilized a communication application on their phone to communicate with R1.

LPA conducted interviews with R1, staff, and witnesses. Interview with R1 revealed that despite R1’s cognitive state, R1 enjoys staff and feels cared for. An additional resident interview revealed that staff are nice, and they also feel cared for. A Witness interview to the alleged incident denied knowledge of any statement related to staff threatening to break R1’s arm if they went into the refrigerator. Additionally, a Witness stated that staff assist residents with retrieving items from the refrigerator and will routinely go into the refrigerator at night and ask if residents would like anything. Based on resident interviews, the allegation is Unsubstantiated.

A finding of Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where a copy of this report was discussed with and provided, along with a copy of the LIC811 (confidential names list).

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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