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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366426281
Report Date: 10/15/2021
Date Signed: 10/15/2021 03:42:03 PM



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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/08/2020 and conducted by Evaluator Crystal Colvin
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20200608131822
FACILITY NAME:TERRACE GARDENSFACILITY NUMBER:
366426281
ADMINISTRATOR:MAWIKERE, DEKKIFACILITY TYPE:
740
ADDRESS:22626 FLAMINGO ST.TELEPHONE:
(909) 824-8126
CITY:GRAND TERRACESTATE: CAZIP CODE:
92313
CAPACITY:6CENSUS: 5DATE:
10/15/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Dekki Mawikeri - AdministratorTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff is filming residents without permission
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility to deliver findings on an open complaint with the above allegation (s). LPA Colvin identified herself and discussed the purpose of the visit and the elements of the above allegation with Administrator Dekki Mawikeri. Below is a summary of the findings:

Regarding the allegation "Staff is filming residents without permission": The Department conducted investigation of the allegation to include interviews. The allegation is specific to facility staff having filmed a resident (R1) while R1 was receiving emergency services from paramedics. The Administrator and Licensee concede to the fact that on June 8, 2020 staff took photographs of R1 while R1 was receiving emergency services. Per the Administrator photographs were taken of R1at the family’s request. Administrator maintains that while photographs were taken, the staff did not take video. Due to lack of evidence regarding the existence of specifically video footage, the allegation "Staff is filming residents without permission" is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
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-20200608131822
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: TERRACE GARDENS
FACILITY NUMBER: 366426281
VISIT DATE: 10/15/2021
NARRATIVE
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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 Administrator Dekki Mawikeri and a copy of this report was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2