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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425810
Report Date: 05/31/2023
Date Signed: 05/31/2023 10:04:28 AM

Substantiated


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
04/22/2021 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210422152912
FACILITY NAME:DANIEL HOMEFACILITY NUMBER:
336425810
ADMINISTRATOR:PABLO TREJOFACILITY TYPE:
735
ADDRESS:30839 VIA PAREDTELEPHONE:
(760) 565-7905
CITY:THOUSAND PALMSSTATE: CAZIP CODE:
92276
CAPACITY:6CENSUS: 6DATE:
05/31/2023
ANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Administrator Adelina QuintanillaTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff member had an inappropriate relationship with a client.
INVESTIGATION FINDINGS:
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On 05/31/2023 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown met with Administrator Adelina Quintanilla at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to deliver the findings of the above allegation. LPA Brown explained the purpose of the Office Visit. The investigation consisted of file review, interviews with staff and relevant parties as well as observation.

The investigation was conducted by LPA Shaunte Henry last 11/22/2021. The investigation consisted of file review and interviews with relevant parties. The allegation indicates Staff member had an inappropriate relationship with a client. Five out of five staff interviews revealed suspicions of Staff 1 (S1) having an inappropriate relationship with Client 1 (C1).

*** Continuation in LIC9099C ***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
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 3
Control Number 18-AS-20210422152912
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
RIVERSIDE, CA 92507
FACILITY NAME: DANIEL HOME
FACILITY NUMBER: 336425810
VISIT DATE: 05/31/2023
NARRATIVE
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On 05/25/2023, LPA Melody Brown interviewed C1 and C1 reported to LPA Brown "I refused to answer your questions."

On 3/31/21, LPA Henry reported that S1 and C1 were seen by Staff 5 (S5) sitting on the couch underneath the same blanket and were tickling each other. On the same day, S5 witnessed C1 and S1 walking into C1's bedroom. They came out of the bedroom 2.5 hours later.

On 4/2/21, LPA Henry reported that C1 attempted to bribe Staff 4 (S4) with money to leave them and S1 alone. C1 told S4 that they and S1 were together. On the same day, S1 was seen by S4 going into C1's room and not coming out for an extended amount of time. S1 and C1 were also seen sitting on the couch underneath a blanket in the dark.

On 4/7/21, LPA Henry reported that Staff 5 (S5) witnessed C1 and S1 sitting on the couch and sharing a blanket. On the same day, S1 and C1 went into C1's bedroom at approximately 12:00 AM and did not come out of the bedroom until 3:00 AM.

On 4/10/21, LPA Henry reported that Staff 6 (S6) witnessed S1 wearing C1's sweatshirt. That same day, S1 was seen playing on C1's skateboard.

On 4/11/21, LPA Henry reported that Staff 7 (S7) reported to management that they witnessed S1 wearing C1’s sweatshirt.

On 4/15/21, LPA Henry reported that S1 met with management prior to the beginning of their shift and was placed on suspension while management conducted an investigation. The facility investigation concluded that S1 was having an inappropriate relationship with C1. S1 was terminated on 04/21/2021. The facility reported the incident to C1's consumer service coordinator, C1's responsible party, Inland Regional Center (IRC), and Community Care Licensing Division (CCLD).

Based on LPAs observations and interviews, which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099, LIC9099D, and Appeal Rights were discussed and provided to Administrator Adelina Quintanilla.

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

DATE: 05/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210422152912
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
RIVERSIDE, CA 92507

FACILITY NAME: DANIEL HOME
FACILITY NUMBER: 336425810
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/31/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/01/2023
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement was not met as evidenced by:
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Licensee stated they immediately terminated Staff 1 (S1) and provided proof of staff termination to LPA Brown by POC due date. Licensee stated to submit signed Statement of Understanding on CCR 80065(a) and submit to LPA Brown by POC due date.
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Based on interviews and file review, the Licensee did not comply with the section cited above by allowing S1 to have an inappropriate relationship with C1 and staffs witnessed these behaviors on different occasions which pose immediate health, safety and personal rights risks to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
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