336426054-12-7-2023-18-AS-JDHS-CZYVEZ-20240130152310

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 12/07/2023
Date Signed: 12/07/2023 01:56:11 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
12/04/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231204124643

FACILITY NAME:	CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER		FACILITY NUMBER:	336426054
ADMINISTRATOR:	MARIA ARRIAGA		FACILITY TYPE:	740
ADDRESS:	47805 CALEO BAY DRIVE		TELEPHONE:	(760) 771-6100
CITY:	LA QUINTA	STATE: CA	ZIP CODE:	92253
CAPACITY:	66	CENSUS: 47	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Maria Arriaga, Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff physically abused resident while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to commence a complaint investigation in regards to the allegation noted above. LPA met with Executive Director Maria Arriaga and explained the purpose of the visit. The allegation was investigated, and the investigation consisted of observations, interviews and records review.

It was alleged that on or around 12/01/23, Staff #1 (S1) had grabbed Resident #1 (R1)s arm, and pulled out a chunk of R1's hair. R1 was observed to have marks on their right forearm that were red in color and estimated to have been 1-1.5 inches in size. LPA reviewed documentation (photos) of R1 that revealed that R1 did in fact had a chunk of hair measuring an estimated 1.5 inches wide of hair that fell out, when Exectuive Director Maria observed for R1s hair to be sticking up, and when Maria went to pat R1's hair down, the chuck of hair fell out. LPA observed for R1 to already have a bald spot in the middle of their head, and could not be confirmed if R1s hair had fallen out on its own due to natural hair loss or if it was pulled out. LPA conducted resident file reviews and reviewed narrative charting date 11/1/23, that an outside

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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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Control Number 18-AS-20231204124643

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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER	FACILITY NUMBER: 336426054
	VISIT DATE: 12/07/2023

NARRATIVE

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party made the request for S1 not take care of Resident #2 (R2), as they felt S1 was rough and upsets R2. On 11/30/23, Further documentation revealed that Resident #3 (R3) made the statement while being in the hallway and observing S1 and stating "hey that's the one had pulled my hair". Per Executive Director Maria a body check was conducted and there were no visible marks or bruises observed. In addition S1 denied the allegation, and handling any residents in a rough manner and pulling their hair. S1 stated that most residents require

Per an interview conducted with R1, R1 could not identify S1 when shown a picture or recall the incident. R2 and R3 were unable to be qualified as a witnesses due to their medical diagnosis. On 12/01/23 the facility called and self reported the incident, and explained the actions that were taken as well as there was an active investigation pending and the staff was suspended and unable to return to work until the conclusion of the investigation, which will lead to termination of employment.

Therefore based on observations, interviews and records review the allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred.

An exit interview was conducted and a copy of report was reviewed and provided to Maria Arriaga, Executive Director.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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