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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405765
Report Date: 09/21/2022
Date Signed: 09/21/2022 01:41:29 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
03/24/2021 and conducted by Evaluator Natalie Ibarra
COMPLAINT CONTROL NUMBER: 18-AS-20210324110003
FACILITY NAME:CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLAFACILITY NUMBER:
366405765
ADMINISTRATOR:RODNEY PEEKFACILITY TYPE:
735
ADDRESS:22200 HIGHWAY 18TELEPHONE:
(760) 247-7711
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:54CENSUS: 33DATE:
09/21/2022
UNANNOUNCEDTIME BEGAN:
01:04 PM
MET WITH:Rodney PeekTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident is having sex with other residents in facility
Night staff not supervising residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Natalie Gayoso Ibarra made an unannounced visit to the facility to deliver findings. LPA met with administrator Rodney Peek and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties.

The first allegation indicates resident is having sex with other residents in facility. LPA interview Client #2 (C2) and Client #3 (C3) who both stated they have never had sex with Client #1 (C1). Interviews with Staff #3 (S3), Staff #4 (S4), Staff #5 (S5), Staff #6 (S6), and Staff #7 (S7) state they have never witnessed nor heard of C1 having sex with C2 and/or C3. S6 and S7 stated that C2 inform them both that they did not have sex with C1.

The second allegation indicated night staff not supervising residents. Interviews with C2 and C3 stated facility night staff do supervise residents at the facility. Interviews with S3, S4, S5, S6, and S7 stated they have never witnessed the night staff not supervising the residents at the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
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-20210324110003
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: CASA COLINA CENTERS FOR REHABILITATION/PADUA VILLA
FACILITY NUMBER: 366405765
VISIT DATE: 09/21/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
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19
20
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32
S4 and S5 stated there is always 2 staff sitting in the hallway at night. S4 also stated the staff sit facing rooms and have eye visual.

Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to the Administrator
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 09/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2