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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200656
Report Date: 08/30/2023
Date Signed: 08/30/2023 11:32:45 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/30/2023 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20230530205031
FACILITY NAME:JAY MAHLER RECOVERY CENTERFACILITY NUMBER:
019200656
ADMINISTRATOR:GARCIA, DENISE GFACILITY TYPE:
772
ADDRESS:15430 FOOTHILL BOULEVARDTELEPHONE:
(510) 357-3562
CITY:SAN LEANDROSTATE: CAZIP CODE:
94578
CAPACITY:16CENSUS: 15DATE:
08/30/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Denise Garcia, AdministratorTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Facility staff denied resident visitors.
INVESTIGATION FINDINGS:
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On 08/30/23 around10:15 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint finding for the above allegation. LPA met with Denise Garcia, Administrator (ADM) and explained the purpose of the visit the visit.

During the visit LPA interviewed ADM, Client #1 (C1), Witnesses (W1, W2), reviewed, and obtained documents from ADM. LPA requested copies to be emailed from C1's file including, but not limited to the following documents: LIC500, Client Roster, House Rules, Admission Agreement, Physician’s Reports, Appraisal/Needs and Services Plan, Medication Administration Records (MAR), Recovery Center Intake and Referral form, Documentation of Conservatorship, 05/15/23 Hospital Discharge Summary, Client Episode and Closing sheet, Identification and Emergency Contact form, emails and/or correspondences with conservator.

Continued on LIC9099C...

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
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 15-AS-20230530205031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: JAY MAHLER RECOVERY CENTER
FACILITY NUMBER: 019200656
VISIT DATE: 08/30/2023
NARRATIVE
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...continued from LIC9099

For the allegation: facility staff denied resident visitors, and email exchange on 05/30/23 between ADM, W1, W3, and W4 indicates that W4 is in support of denying visitation for C1. C1 stated that he/she did not visit with W2 on 05/28/23. Per C1’s signed House Rules #11, dated 05/17/23, visitation is encouraged during visiting hours. W2 stated that when he/she first arrived at the facility on 05/28/23, an unknown staff member brought C1 to the door. Shortly after, another unknown staff member came to the door and said C1 was not allowed visitors…not any visitors. W2 was not offered any alternatives and left the facility. ADM stated that C1 was not denied visitation. W1 stated that he/she has visited C1 about two (2) times after the complaint was filed on 05/30/23, but the visits were supervised. LPA and ADM discussed the facility’s admission agreement, and methods of ensuring the safety of clients without limiting the personal rights of clients in care.

Based on LPA’s interviews conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), is being cited on the attached LIC 9099D.

Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided to ADM.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 15-AS-20230530205031
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: JAY MAHLER RECOVERY CENTER
FACILITY NUMBER: 019200656
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/05/2023
Section Cited
CCR
85072(b)(4)
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85072 Personal Rights (b) The licensee shall insure that each client is accorded the following personal rights. (4) To have visitors, including advocacy representatives, visit privately during waking hours...
-This requirement was not met as evidenced by:
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Licensee agreed to review and inform staff of clients personal rights and submit self-certification to CCL on or before the POC due date.
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Based on records reviewed and interviews, the personal rights of C1 were infringed by not allowing visitation for C1.
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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.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3