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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881169
Report Date: 01/31/2024
Date Signed: 01/31/2024 04:12:03 PM

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
01/31/2024 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240131121345
FACILITY NAME:ANDREW VILLA LLCFACILITY NUMBER:
361881169
ADMINISTRATOR:GHAREB, RAWANFACILITY TYPE:
735
ADDRESS:27051 VILLA AVETELEPHONE:
(909) 280-3783
CITY:HIGHLANDSTATE: CAZIP CODE:
92346
CAPACITY:6CENSUS: 1DATE:
01/31/2024
UNANNOUNCEDTIME BEGAN:
02:40 PM
MET WITH:Rawan GharebTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff made inapprorpiate comments towards resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Anna Bueno and Bianca Wolcott conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegations. LPAs met with licensee Rawan Ghareb who was advised of the purpose of visit. The investigation consisted of records review and interviews with relevant parties.

The allegations is Staff made inappropriate comments towards resident. LPAs reviewed records showing Resident's documented behavior of making false statements. Interview with Staff denied that speaking inappropriately to Resident. Interview with Resident made no mention of Staff using inappropriate language towards Resident.

Based on the information available during this investigation, the Department has found the complaint allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed and provided to Licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024
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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