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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336424643
Report Date: 12/14/2023
Date Signed: 05/06/2024 03:38:40 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
11/19/2020 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20201119094121
FACILITY NAME:COUNTRY VIEW HOUSE 2FACILITY NUMBER:
336424643
ADMINISTRATOR:JOCELYN DIANAFACILITY TYPE:
735
ADDRESS:13809 CALIENTE DR.TELEPHONE:
(760) 671-7666
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:6CENSUS: 6DATE:
12/14/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Carmelita Gregorio, LicenseeTIME COMPLETED:
06:23 PM
ALLEGATION(S):
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Facility violating fire clearance with key-lock security door

*This is an amended version of the original report created on 12/14/2023.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Jacqueline Shaw Ross made an unannounced visit to deliver findings for the allegations noted above. LPA met with Carmelita Gregorio, Licensee and explained the purpose of the visit and the elements of the allegations. The investigation consisted of observations, interviews, and records review.

On 11/19/2020, the Department received a complaint that the facility is violating fire clearance with a key-lock security door. This allegation was observed to be true during two visits to the facility. On 11/19/2020, the complaint investigation was initiated via FaceTime due to Covid 19 restrictions. LPA Pauline Beschorner observed a key lock on the security door to the front entry. On 12/13/2023, LPA Shaw Ross conducted a follow-up visit and observed the key lock remained on the security door. At the time of visit, LPA Shaw Ross informed Administrator Jocelyn Dia of the violation and that the key lock had to be removed within 24 hours. The facility will be cited.

Continue on 9099 C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
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 5
Control Number 18-AS-20201119094121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COUNTRY VIEW HOUSE 2
FACILITY NUMBER: 336424643
VISIT DATE: 12/14/2023
NARRATIVE
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Based on the evidence obtained from the complaint investigation, the allegation that facility violated fire clearance with a key-lock security door is SUBSTANTIATED, as there is a preponderance of evidence to show that the allegation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6. This poses a health and safety and or personal rights risk to all clients in care.

An exit interview was conducted. A copy of this report, along with the 9099-D, was provided to Licensee, Carmelita Gregorio.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
11/19/2020 and conducted by Evaluator Jacqueline Shaw Ross
COMPLAINT CONTROL NUMBER: 18-AS-20201119094121

FACILITY NAME:COUNTRY VIEW HOUSE 2FACILITY NUMBER:
336424643
ADMINISTRATOR:JOCELYN DIANAFACILITY TYPE:
735
ADDRESS:13809 CALIENTE DR.TELEPHONE:
(760) 671-7666
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:6CENSUS: DATE:
12/14/2023
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:TIME COMPLETED:
06:23 PM
ALLEGATION(S):
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Facility is not keeping receipts for purchases made with residents' money
Facility is not providing residents with P&I money (financial abuse)
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jacqueline Shaw Ross conducted an unannounced visit to the facility to deliver findings regarding the above allegations. LPA met with --- and explained the purpose of the visit. During the course of the investigation into the complaint, LPAs conducted visits, toured the facility, conducted interviews and made observations. LPA was unable to interview residents additional witness in order to obtain pertinent information regarding the allegation due to the inability to obtain contact.

On 11/19/2020, the Department received a complaint of the allegation that the facility is not keeping receipts for purchases made with residents money and the facility is not providing residents with monies. Information obtained from resident interviews advised that most residents handle their own finances; therefore, facility staff would not need to retain receipts for resident's purchases. LPA reviewed residents Personal and Incidental (P&I) logs and observed notations in the logs that residents handled their own money.

Continue on LIC 9099 C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20201119094121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: COUNTRY VIEW HOUSE 2
FACILITY NUMBER: 336424643
VISIT DATE: 12/14/2023
NARRATIVE
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Continue from LIC 9099...

LPA was also informed by Administrator ---that each resident receives all of their P&I up front on the first of each month and residents have the ability to decide how they want to spend their own money. Administrator stated she did not think it was required to ask for receipts, unless her were residents under conservatorship. Based on record reviews and interviews, this allegation is deemed UNSUBSTANTIATED at this time.

In regards to the allegation that the facility is not providing resident with P&I money, LPA attempted to contact Resident #1 (R1), but was unsuccessful. Information obtained from resident interviews stated that 2 out of 2 indicated they were receiving their P&I funds on a regular basis. Reviews of the financial logs indicated dates monies were released to residents, as well as, resident's signatures. LPA compared resident signatures to other paperwork signed by residents and signatures appeared authentic.

Based on record reviews and interviews, the allegations that facility is not keeping receipts for purchases made with residents money and facility is not providing residents with monies are deemed UNSUBSTANTIATED- .

An exit interview was conducted with -- and a copy of this report was provided.

*This is an amended version of an original report dated 12/14/2023.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 05/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20201119094121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: COUNTRY VIEW HOUSE 2
FACILITY NUMBER: 336424643
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/14/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/22/2023
Section Cited
HSC
80087(a)
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Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times...This requirement was not met as evidenced by...
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Licensee had the key lock removed from the security door within 24 hours on the same day of the follow-up visit on 12/13/23.
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LPA observed a key lock installed on the security door of the main entrance door. This poses a potential risk to the safety of all clients in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5