197608598-10-4-2021-31-AS-NGID-C93TF5-20211124134055

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608598
Report Date: 10/04/2021
Date Signed: 10/04/2021 02:05:15 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2021 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20210930091756

FACILITY NAME:	MOLOCK RESIDENTIAL INC.		FACILITY NUMBER:	197608598
ADMINISTRATOR:	JONATHAN ALLEN MOLOCK		FACILITY TYPE:	735
ADDRESS:	44333 STADIUM COURT		TELEPHONE:	(661) 674-8592
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93535
CAPACITY:	6	CENSUS: 5	DATE:	10/04/2021
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Monica Vartanian - Administrator		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Facility staff do not provide a variety of meals.
Facility staff does not safeguard resident’s private information.
Residents not accorded dignity in relationship with staff

INVESTIGATION FINDINGS:

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At 10:30 am, Licensing Program Analysts (LPA’s) Shira Stamps and Melissa Ruiz arrived at the facility to conduct an initial complaint visit for the allegations mentioned above. LPAs met with the Administrator, Monica and explained the purpose of this visit.

At approximately 11:10 am, LPA’s began reviewing documents that consisted of but not limited to client’s physician reports, Individualized Personal Plans (IPP’s) and the facility food menu.

LPAs conducted a physical plant tour and LPAs did not observe any immediate health and safety issues during this visit. At 11:55 am, LPAs began interviewing staff and clients. It is alleged that the facility did not provide a variety of meals. LPAs conducted interviews with the Administrator and two (2) staff members, all of which stated that food is provided based on the weekly food menu, a variety of snacks are made at any given time, and food ingredients that aren’t liked by the clients are substituted or omitted from meals.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20210930091756

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: MOLOCK RESIDENTIAL INC.	FACILITY NUMBER: 197608598
	VISIT DATE: 10/04/2021

NARRATIVE

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Two (2) out of five (5) clients stated they don’t always like how the food is prepared, however at approximately 12:00 pm, LPAs observed staff prepare a variety of food for lunch and observed there to be a variety of perishable and non-perishable food supply. Three (3) out of five (5) clients were not able to be interviewed as they are non-verbal. This allegation is deemed unsubstantiated at this time.

Allegation: Facility staff does not safeguard resident’s private information.

LPAs interviewed the Administrator, two (2) staff members and three (3) out of five clients, all of which stated that they have not heard or witnessed any staff member disclose a resident’s private information. Clients stated they have not had a staff member disclose their personal or private information. Based on information obtained from the interviews conducted, this allegation is deemed unsubstantiated at this time.

Allegation: Residents not accorded dignity in relationship with staff.

LPAs interviewed two (2) out of five (5) clients. Both clients stated that they have no issues with the staff or haven’t witnessed a staff member treat other clients without dignity. LPAs also interviewed two (2) staff members and the Administrator, all of whom stated they have a good relationship with the clients and haven’t heard of any issues between clients and staff. The administrator stated she likes to have monthly meetings with all the clients to discuss any issues and no issues among staff and clients have been reported. Based on the information obtained from the interviews conducted, this allegation is deemed unsubstantiated at this time.

No deficiencies cited. Due to a personal appointment, exit interview conducted via telephone with the Administrator. Administrator designated staff member, Sophia Mulatillo to sign the report. Report delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Shira Stamps
LICENSING EVALUATOR SIGNATURE:	DATE: 10/04/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021

LIC9099 (FAS) - (06/04)

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