331881373-5-2-2024-18-AS-TDAN-D5KUJT-20240524153804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881373
Report Date: 05/02/2024
Date Signed: 05/02/2024 12:03:39 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
04/25/2024 and conducted by Evaluator Janette Romero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240425162329

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: 3	DATE:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Administrator, Anahit Mesropyan		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 5/2/2024, Licensing Program Analyst (LPA) Janette Romero made an unnanounced visit at the facility to investigate the allegation listed above. LPA met with Administrator, Anahit Mesropyan.

It was alleged that facility staff hit Resident 1 (R1) when R1 does not comply with staff's requests. Staff 1 (S1) and Staff 2 (S2) were listed as possible suspected abusers. S1 and S2 were interviewed and denied hitting any residents or observing R1 ever being hit by staff. During today's visit, LPA toured the facility, conducted staff and resident interviews and obtained copies of pertinent documentation. There are three (3) residents currently residing in the facility, which were interviewed by LPA.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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 2

Control Number 18-AS-20240425162329

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: 05/02/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Two (2) of three (3) resident interviews conducted reported they have never been physically and/or mentally abused by facility staff. Two (2) of three (3) resident interviews reported witnessing R1 verbally abuse S1 during one (1) occasion and denied observing S1 physically/verbally abuse R1. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Administrator, Mesropyan.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janette Romero
LICENSING EVALUATOR SIGNATURE:	DATE: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2