336410270-1-12-2023-18-AS-DMUN-CN9VGV-20230120152610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410270
Report Date: 01/12/2023
Date Signed: 01/12/2023 05:10:34 PM

Unfounded

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
01/11/2023 and conducted by Evaluator Tricia Danielson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230111160255

FACILITY NAME:	CHRISTMAS COTTAGE		FACILITY NUMBER:	336410270
ADMINISTRATOR:	ROSALYNNE VALIENTE		FACILITY TYPE:	740
ADDRESS:	330 S. SAN JACINTO ST		TELEPHONE:	(951) 765-1840
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	14	CENSUS: 14	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	03:55 PM
MET WITH:	Kay Hyland,		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Staff is forcing a resident to shower while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Kay Hyland, Manager and explained the purpose of the visit.
During today's visit, LPA interviewed one(1) staff, one(1) resident, and reviewed and obtained copies of records pertaining to Resident #1(R1). Interview with R1 indicated they enjoy taking showers, has not told anyone they are forced to take a shower, and enjoys living at the facility. Review of R1's records also revealed R1 enjoys soap. Interviews conducted also revealed R1 is always pleasant, compliant with all aspects of their care, and has not verbalized or expressed any refusal to shower. Records reviewed indicated R1 is showered twice weekly and as needed. This agency has investigated the complaint alleging "Staff is forcing a resident to shower while in care". We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names List.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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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