<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107209545
Report Date: 06/03/2025
Date Signed: 06/03/2025 04:35:54 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2025 and conducted by Evaluator Katie Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20250528130643
FACILITY NAME:M&M CARE HOMEFACILITY NUMBER:
107209545
ADMINISTRATOR:ALFONSO, MARY ANNFACILITY TYPE:
735
ADDRESS:5937 W SAN GABRIEL AVETELEPHONE:
(559) 375-3487
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:4CENSUS: 4DATE:
06/03/2025
UNANNOUNCEDTIME BEGAN:
03:06 PM
MET WITH:Mary Ann AlfonsoTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is violating residents personal rights.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the initial complaint investigation. LPA met with and explained the reason for the visit and the discussed the allegation with Administrator (AD) Mary Ann Alfonso.

During the visit, LPA conducted interviews and record review. On 5/27/25, Resident (R1) requested AD call 911. When AD left the room for the phone, R1 locked the door, not allowing AD to observe or report on R1's condition to dispatch as R1 had been displaying self injerous behavior. Interviews also reveal conflicting reports that a male caregiver told R1 to keep the door unlocked. Based on interview and record review the above allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur.

There were no citations issued. An exit interview was conducted and a copy of this report was left with AD
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Katie Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2025
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 1