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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 134604599
Report Date: 03/10/2023
Date Signed: 03/10/2023 11:37:08 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/03/2023 and conducted by Evaluator Marisela Garcia-Centeno
COMPLAINT CONTROL NUMBER: 08-AS-20230303145921
FACILITY NAME:MACKENZIE CARE HOME IIFACILITY NUMBER:
134604599
ADMINISTRATOR:RAQUEL PREECE&DEREKHAMPTONFACILITY TYPE:
735
ADDRESS:484 CORRAL CTTELEPHONE:
(760) 545-0364
CITY:IMPERIALSTATE: CAZIP CODE:
92251
CAPACITY:4CENSUS: 3DATE:
03/10/2023
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:House Manager, Giovanna LiraTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Staff verbally abused prospective client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint investigation visit to open an investigation on the above allegation. LPA was granted entry by House Manager, Giovanna Lira, and spoke by telephone with Administrator, Raquel Preece to whom she discussed the purpose of the visit. During this visit, LPA conducted additional interviews and reviewed records, then concluded the investigation and delivered findings.

The Department investigated the above listed complaint allegation. The investigation consisted of review of relevant records, including staff training records and interviews with facility staff and outside sources.

On March 3, 2023, Community Care Licensing (CCL) received a complaint alleging that facility staff (S1) verbally abused a prospective client (C1), [an LIC 811 Confidential Names List was provided to staff to identify the client and staff].
(Continue on LIC9099C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
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 08-AS-20230303145921
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: MACKENZIE CARE HOME II
FACILITY NUMBER: 134604599
VISIT DATE: 03/10/2023
NARRATIVE
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(Continue from LIC9099)

It was specifically alleged that on March 2, 2023, while C1 was visiting the facility, an incident occurred that caused C1 to become behaviorally aggressive. As a result, S1 communicated to C1 they would not be accepting C1’s admission into the facility, which significantly affected C1’s emotional state. C1 was known to staff to have behaviors of verbal outbursts linked to their cognitive disabilities. On this day, it was observed by witnesses that C1 was experiencing these typical behaviors. Multiple interviews with outside sources who witnessed the incident revealed that S1 made loud inappropriate statements and used verbally abusive language directed at C1. In addition, outside sources stated that S1 made derogatory statements about C1 when describing the incident to outside sources in the presence of C1 and another client in care.

S1 denied the allegation. Review of personnel records determined that S1 had received required initial training which included client’s personal rights.

We have found there is a preponderance of evidence to prove the alleged violation occurred and is therefore substantiated. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Administrator.

An exit interview was conducted with House Manager, Lira, Administrator, Preece joined in via telephone; a copy of this report, Deficiency LIC9099D, LIC811 and Licensee's Rights (LIC9058) were provided to House Manager, Lira.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20230303145921
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MACKENZIE CARE HOME II
FACILITY NUMBER: 134604599
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
03/31/2023
Section Cited
CCR
80072(a)(1)
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80072(a)(1) Personal Rights.
Personal Rights. To be accorded dignity in his/her personal relationships with staff and other persons.
This requirement was not met as evidenced by:
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Licensee agreed to conduct additional training on personal rights with all staff, including S1. Licensee will submit sign in sheets and training materials as verification by POC date of March 31, 2023.
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Interviews revealed that staff S1 verbally abused prospective client C1. This posed a potential personal rights risk to three (3) 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.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3