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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336423576
Report Date: 01/09/2024
Date Signed: 01/09/2024 10:19:04 AM

Unsubstantiated


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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/28/2023 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20231228083729
FACILITY NAME:PEACEFUL LIVING #2FACILITY NUMBER:
336423576
ADMINISTRATOR:RUSH, JOEFACILITY TYPE:
735
ADDRESS:1112 PEACEFUL DRIVETELEPHONE:
(951) 531-8134
CITY:CORONASTATE: CAZIP CODE:
92880
CAPACITY:6CENSUS: 4DATE:
01/09/2024
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Licensee/Administrator Lena RushTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff did not treat client in care with dignity and respect.
INVESTIGATION FINDINGS:
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On 11/09/2024, Licensing Program Analysts (LPAs) Melody Brown and Bianca Wolcott conducted an unannounced visit to the facility to interview residents, review documents and deliver findings on a complaint investigation. LPAs Brown and Wolcott were greeted and granted entrance to the facility by Licensee/Administrator Lena Rush. LPAs Brown and Wolcott explained the purpose of today's visit.

The investigation was conducted by LPAs Brown and Wolcott. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Staff did not treat client in care with dignity and respect. During the investigation, LPAs Brown and Wolcott did not find evidence to corroborate the allegation. Interviews with Client #1 (C1), Client #2 (C2) and Client #3 (C3) all indicated that staff at the facility are all treating them good, with dignity and respect. C1, C2 and C3 added that staff at the facility are serving them the same food and no special food were served to other clients.
*** Continuation on LIC9099C ***

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
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 56-AS-20231228083729
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: PEACEFUL LIVING #2
FACILITY NUMBER: 336423576
VISIT DATE: 01/09/2024
NARRATIVE
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 Interviews with Staff #1 revealed that they are always treating their clients with dignity and respect and their clients are their family and no incident happened at the facility that a staff gave a special food to a client as all clients at the facility get the same food during meal times. Moreover, LPAs Brown and Wolcott contacted C1 Inland Regional Center (IRC) Case Worker and IRC Case Worker reported to LPAs Brown and Wolcott that C1 has tendency to make falsifying statement. IRC Case Worker stated "It's not uncommon for C1 to make false statement. C1 does that very often. C1 has that history."

Based on interviews and records review, the allegation Staff did not treat client in care with dignity and respect 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 violations did or did not occur.

An exit interview was conducted, where this report (LIC9099) was discussed and provided to Licensee/Administrator Lena Rush.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2