361881193-11-17-2023-56-AS-NBRN-CXZQG6-20231128110857

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361881193
Report Date: 11/17/2023
Date Signed: 11/17/2023 12:55:46 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/09/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230809095524

FACILITY NAME:	CANYON VIEW CARE HOMES		FACILITY NUMBER:	361881193
ADMINISTRATOR:	VERMANI, NITIN		FACILITY TYPE:	740
ADDRESS:	6369 VINEYARD AVE		TELEPHONE:	(909) 548-1769
CITY:	ALTA LOMA	STATE: CA	ZIP CODE:	91701
CAPACITY:	6	CENSUS: 6	DATE:	11/17/2023
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Yvonne Gonzalez, Facility/House Manager		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident wandered away from facility due to lack of supervision.
Staff did not notify responsible parties of a resident's unexplained absence from facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Canyon View Care Home to deliver findings for the complaint investigation into the allegations listed above. LPA introduced self and stated purpose of the visit. LPA was greeted and granted entry by House Manager, Yvonne Gonzalez. LPA informed Administrator, Nick Vermani was not present. LPA contacted Administrator to notify of visit and delivery of findings.

It is alleged that a resident wandered away from the facility due to lack of supervision. According to staff interviews, R1 did not leave the facility grounds. R1 walked out of the door, but was caught by staff before reaching the perimeter of the facility. LPA was unable to gather any information about the incident from R1 during the interview. Statement of the witness conflicts with the statements of staff. LPA unable to obtain the Police Report for the incident.

Please see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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 56-AS-20230809095524

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CANYON VIEW CARE HOMES	FACILITY NUMBER: 361881193
	VISIT DATE: 11/17/2023

NARRATIVE

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It is alleged that staff did not notify responsible parties of a resident’s unexplained absence from the facility. Staff interviews revealed that during the period of time the resident was at the facility. There were several incidents that occurred; of which the facility did contact R1’s responsible parties. All staff report that the resident’s responsible parties would not answer their calls or return their calls. Staff contends that messages were left. The primary contact for R1 is R1’s son; who reportedly works long hours and is not available to take calls. Messages were left for the son, but there no response or indication that the messages were received by the son. Collateral contact contends that the Police were called to the facility based on the resident’s behaviors; not because R1 was found wandering outside by the Police. LPA was unable to obtain the Police Report for further investigation.

Based on the interviews, observations and record reviews, these allegations are UNSUBSTANTIATED. 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 with facility representative. This report was discussed, reviewed and then provided to facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 11/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023

LIC9099 (FAS) - (06/04)

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