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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366405765
Report Date: 11/02/2022
Date Signed: 11/02/2022 02:57:13 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
01/12/2021 and conducted by Evaluator Natalie Ibarra
COMPLAINT CONTROL NUMBER: 18-AS-20210112143531
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: 34DATE:
11/02/2022
UNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Rodney PeekTIME COMPLETED:
03:06 PM
ALLEGATION(S):
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2
3
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7
8
9
Staff is sexually abusing resident in care.
Food services are inadequate.
Staff did not seek medical attention for resident(s) in a timely manner.
Staff speak inappropriately to residents in care.
Staff threw an object at a resident in care.
Staff yell at residents in care.
Resident's needs are not being met.
Staff drink alcohol while on the premises.
INVESTIGATION FINDINGS:
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7
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13
Licensing Program Analysts (LPAs) Natalie Gayoso Ibarra and Paola Guerrero made an unannounced visit to the facility to deliver findings for the above allegations. 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 staff is sexually abusing resident in care. Interviews with Staff #2 (S2), #3 (S3), #4(S4), #5 (S5), and #6 (S6) stated they have never witnessed Staff #7 (S7) sexually abusing C10 nor any other staff sexually abusing any of the other clients in care. Interview with Client #10 (C10) stated they have never been sexually abused nor been sexually active with S7.

The second allegation indicates food services are inadequate. Interviews with S1, S2, S3, S5, and S6 stated food services at the facility are adequate. S1 and S6 stated the facility quarterly menus are made by the nutritionist at Casa Colina Hospital.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
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 3
Control Number 18-AS-20210112143531
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: 11/02/2022
NARRATIVE
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S1 stated meals are based on a 2000 calories per day diet by the nutritionist. Interviews with C3, C4, C6, C7, and C8 stated the food service at the facility is adequate and like the food. C2, C3, C4, C5, and C8 have stated the food served at the facility is not burnt nor cold.

The third allegation indicates staff did not seek medical attention for resident(s) in a timely manner. Interviews with S1, S2, S3, S4, S5, and S6 have stated the facility does seek medical attention for the clients at the facility. Interviews with C1, C2, C4, C5, C5, and C6 have all stated that staff do seek medical attention in a timely manner for residents. C1 stated they have never been left in pain and not gotten medical attention

The fourth allegation indicates staff speak inappropriately to residents in care. Interviews with C1, C3, C4, C5, C6, C8, and C9 stated staff do not speak inappropriately to them or other clients care. Interviews with S2, S3, S4, and S5 stated they have never witnessed staff speak inappropriately to the clients.

The fifth allegation indicates staff threw an object at a resident in care. Interviews with S2, S3, S4, S5, and S6 stated they have never witnessed S10 throw cigarettes to C6. Interview with C6 stated S10 has never thrown cigarettes nor any other object at them.

The sixth allegation indicates staff yell at residents in care. Interviews with S2, S3, S4, S5, and S6 stated they have never yelled nor witness staff yell at the clients. Interviews with C1, C3, C4, C5, C6, and C8 stated staff have never yelled at them or witnessed staff yell at other clients.

The seventh allegation indicates resident's needs are not being met. Interviews with C1, C3, C4, C5, C6, and C8 stated their needs at the facility are being met. Interviews with S1, S2, S3, S4, and S5 stated facility makes sure that clients needs are being met.

The eight allegation staff drink alcohol while on the premises. Interviews with S1, S2, S3, S4, S5, and S6 stated they have never witnessed NOC shift nor other staff drink alcohol while on premises. Interviews C1, C2, C3, C4, C5, C6, C7, C8, and C9 stated they have never witnessed NOC shift nor other staff drinking at the facility

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20210112143531
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: 11/02/2022
NARRATIVE
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Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was discussed and provided to Administrator Rodney Peek
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3