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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426054
Report Date: 11/09/2022
Date Signed: 11/09/2022 11:37:54 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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2022 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220214132232
FACILITY NAME:CALEO BAY ALZHEIMER'S SPECIAL CARE CENTERFACILITY NUMBER:
336426054
ADMINISTRATOR:WILKIN, RONDAFACILITY TYPE:
740
ADDRESS:47805 CALEO BAY DRIVETELEPHONE:
(760) 771-6100
CITY:LA QUINTASTATE: CAZIP CODE:
92253
CAPACITY:66CENSUS: 58DATE:
11/09/2022
UNANNOUNCEDTIME BEGAN:
10:31 AM
MET WITH:Anthony Aniasco, Community Development DirectorTIME COMPLETED:
11:43 AM
ALLEGATION(S):
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Resident was physically abused while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced complaint visit to deliver the findings of the above allegation. LPA met with Community Development Director Anthony Aniasco and conducted a tour of the facility. The Department's investigation included interviews with staff and residents and a review of facility documentation.

Staff who were interviewed denied causing injury or having knowledge of anyone else causing injuries to Resident One (R1). Interviews with facility residents were attempted but due to cognitive impairment, interviews were unattainable.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
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-20220214132232
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: CALEO BAY ALZHEIMER'S SPECIAL CARE CENTER
FACILITY NUMBER: 336426054
VISIT DATE: 11/09/2022
NARRATIVE
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On the night of the incident, R1’s spouse took R1 to the hospital. Medical records document the observance of “small scattered bruises” but indicated “no evidence “of traumatic injuries” as being noted.

R1 was unable to be interviewed due recent medical changes that left R1 unable to speak and with a diminished cognitive ability. Law Enforcement responded on the night of the incident and identified two bruises on R1; one on R1’s neck and one on R1’s hand. The deputy indicated the bruises did not appear to originate from an assault. The investigation did not provide corroborating evidence to state the resident was physically abused.

Therefore based on the investigation, the allegation that R1 was physically abused while in care is UNSUBSTANTIATED. This means that although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation did occur.

An exit interview was conducted and a copy of this report was discussed with and provided to Executive Director Maria Arriaga.

SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 11/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2