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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880736
Report Date: 02/13/2023
Date Signed: 02/13/2023 10:59:51 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
02/07/2023 and conducted by Evaluator Rayshaun Nickolas
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230207154955
FACILITY NAME:VILLA'S ADULT RESIDENTIAL HOMEFACILITY NUMBER:
361880736
ADMINISTRATOR:DRAYTON MCCALL, SHERRYFACILITY TYPE:
735
ADDRESS:11262 VILLA STTELEPHONE:
(760) 523-1607
CITY:ADELANTOSTATE: CAZIP CODE:
92301
CAPACITY:3CENSUS: 2DATE:
02/13/2023
UNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Sherry Drayton McCall, Licensee/AdministrationTIME COMPLETED:
11:05 AM
ALLEGATION(S):
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Resident is not served nutritious meals
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rayshaun Nickolas and Michelle Echeverria made an unannounced visit to the facility to initiate a complaint investigation into the above allegation. LPA Nickolas and Echeverria met with Licensee/Administrator Sherry Drayton McCall and explained the purpose of the visit. The investigation consisted of file reviews, facility tour, and interviews with relevant parties.

The allegation alleges that resident # 1 (R1) is never given fresh food. LPAs observed that the facility's food supplies were labeled with purchase dates and adequately stored. The facility had more than a seven (7) day supply of non-perishable foods and a two (2) day supply of perishable food. LPAs observed that the facility's fresh fruits and vegetables were in good condition. LPAs observed plenty of fresh fruits and vegetables at the facility. LPAs also observed a weekly food menu located in the facility's kitchen. The finding is Unsubstantiated. Investigation into this incident reveals insufficient evidence to corroborate the allegation.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
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 56-AS-20230207154955
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: VILLA'S ADULT RESIDENTIAL HOME
FACILITY NUMBER: 361880736
VISIT DATE: 02/13/2023
NARRATIVE
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A finding of Unsubstantiated means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted and copy of this report was provided.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Rayshaun Nickolas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3