361881169-1-31-2024-56-AS-NBRN-D2MTE5-20240220133923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881169
Report Date: 01/31/2024
Date Signed: 01/31/2024 04:12:25 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
01/26/2024 and conducted by Evaluator Anna Bueno

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20240126115833

FACILITY NAME:	ANDREW VILLA LLC		FACILITY NUMBER:	361881169
ADMINISTRATOR:	GHAREB, RAWAN		FACILITY TYPE:	735
ADDRESS:	27051 VILLA AVE		TELEPHONE:	(909) 280-3783
CITY:	HIGHLAND	STATE: CA	ZIP CODE:	92346
CAPACITY:	6	CENSUS: 1	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	Rawan Ghareb		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Licensee hit residents in care.
Licensee threatens residents in care.

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 are that Licensee hit residents in care and Licensee threatens residents in care. LPAs reviewed facility videos showing that Client 1 (C1) engaged in self injurious behavior. LPAs observed Client 2 (C2) without any signs or symptoms of injury. LPAs reviewed records showing C1's documented behavior. Interview with Licensee denied that they hit or threaten residents in care. Witness interviews deny observing C1 with signs or symptoms of injury. LPAs were unable to find corroborating evidence for these allegations.

Based on interviews and observations, and although the above allegations may have occurred or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time. 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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