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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800085
Report Date: 07/03/2025
Date Signed: 07/03/2025 10:58:57 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/23/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250423123006
FACILITY NAME:MCCOY ADULT GROUP HOMEFACILITY NUMBER:
331800085
ADMINISTRATOR:LACY,TORIFACILITY TYPE:
735
ADDRESS:1113 GARRETSON AVETELEPHONE:
(909) 437-5262
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:6CENSUS: 4DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Charisse Mccoy- CEOTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
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5
6
7
8
9
Due to lack of staff, residents are eloping
Staff are leaving residents unsupervised
Staff do not ensure appliances are working properly
Staff are taking away residents personal property as punishment
Staff are limiting tabacoo use for residents
Staff are not criminally record cleared
Staff do not ensure meals are of quantity to meet the needs of the residents
Staff do not allow residents to have visitors
Staff do not have required training
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility CEO Charisse Mccoy and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

First allegation: Due to lack of staff, residents are eloping. Regarding the allegation stated above LPA conducted interviews with four (4) clients pertaining to the allegation stated above and four out of four clients informed LPA that facility always has enough staff that provides adequate supervision. In addition, all clients informed LPA that there is always a staff present at the facility and clients are never left unattended. During interviews clients informed LPA that C#1 leaves the facility when having behaviors outburst however, it is not due to the lack of staffing support. LPA interviewed Facility Administrator who informed LPA that facility has sufficient staff present at the facility and facility has not had any issues regarding clients eloping the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
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 5
Control Number 56-AS-20250423123006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MCCOY ADULT GROUP HOME
FACILITY NUMBER: 331800085
VISIT DATE: 07/03/2025
NARRATIVE
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LPA collected staff schedule. LPA conducted an interview with Staff #1 who informed LPA that facility has sufficient care staff and that the facility has not had incidents pertaining to residents leaving the facility due to lack of staff. Staff #1 informed LPA that staff is always present at the facility.

Second allegation: Staff are leaving residents unsupervised: Regarding the allegation “Staff are leaving residents unsupervised LPA conducted interviews with (4) clients pertaining to the allegation and four out of four clients informed LPA that there is always one staff present at the facility and clients are never left unattended or unsupervised. In addition, all clients informed LPA that they have not witnessed facility to be left unsupervised or unattended while clients in care. LPA conducted an interview with Staff #1 regarding the allegation stated above and S#1 denied witnessing residents to be left unsupervised or left unattended. In addition, all clients informed LPA feeling safe and enjoy living at Mccoy.

Third allegation: Staff do not ensure appliances are working properly. Regarding the allegation “Staff do not ensure appliances are working properly” LPA conducted a walkthrough of the facility and observed that all kitchen appliances are in working condition. In addition, LPA inspected facility AC-unit and witnessed that both heating and cooling system is in working condition. LPA inspected facilities laundry room and observed that both washer and dryer are in good repair. LPA inspected three (3) bathrooms and observed that all appliances in the bathrooms are in good repair. Furthermore, LPA inspected the water temperature and observed that the water temperature (116 F) is to standard.

Fourth allegation: Staff are taking away residents’ personal property as punishment. Regarding the allegation “Staff are taking away residents’ personal property as punishment” LPA conducted interviews with four (4) clients and all four clients denied having their personal property being taking away by staff as punishment. In addition, all clients denied witnessing staff take away personal property from clients. LPA conducted an interview with Staff #1 regarding the allegation stated above S#1 denied taking way personal property from client[s] furthermore, S#1 also denied witnessing other staff take away personal property from clients in care.
Fifth allegation: Staff are limiting tobacco use for residents. Regarding the allegation stated above LPA conducted interviews with clients regarding the allegation “Staff are limiting tobacco use for residents” during the interview four out of four clients deny smoking at the facility. In addition, all clients informed LPA that no client smokes at the facility or have witnessed clients’ smoke. LPA conducted an interview with Staff #1 who informed LPA that no one at the facility smokes in addition, S#1 informed LPA that facility does not have cigarettes or any tobacco products at the facility.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20250423123006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MCCOY ADULT GROUP HOME
FACILITY NUMBER: 331800085
VISIT DATE: 07/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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31
32
Sixth allegation: Staff are not criminally record cleared. Regarding the allegation pertaining to “Staff are not criminally record cleared” LPA conducted an interview with facility administrator who informed LPA that all staff working at the facility is criminally cleared. Administrator provided LPA with staff roster along with guardian facility roster that shows clearance for all staff. LPA inspected staff files and observed clearance forms to be on file for all staff.

Seventh allegation: Staff do not ensure meals are of quantity to meet the needs of the residents. Regarding the allegation stated above LPA conducted an inspection of facilities refrigerator and LPA witnessed facility to have enough food supply to meet the needs of all residents in care. In addition, LPA inspected facilities overflow refrigerator located in the garage to have enough food supply to meet the needs of all residents in care. LPA conducted interviews with clients regarding the allegation and four out of four clients informed LPA that they enjoy the food have no concerns and receive seconds when asked. Four out of four clients informed LPA that they are given the option to choose the meals that they would like to eat and stated that snacks are available daily.

Eight allegation: Staff do not allow residents to have visitors. Regarding the allegation stated above LPA conducted interviews with clients regarding the allegation “Staff do not allow residents to have visitors” during interviews four out of four clients deny staff not allowing clients to have visitors. In addition, all clients denied witnessing staff deny residents visitations. LPA conducted an interview with Staff #1 regarding the allegation S#1 denied not allowing residents to have visitors. In addition, S#1 also denied witnessing other staff deny visitation rights to clients in care.

Ninth allegation: Staff do not have required training. Regarding the allegation stated above LPA conducted a staff file review. During the file review LPA discovered staff to have trainings on file that are required by Inland Regional Center along with CCLD. LPA also observed all training to be current along with certifications. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility CEO Charisse Mccoy at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
04/23/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250423123006

FACILITY NAME:MCCOY ADULT GROUP HOMEFACILITY NUMBER:
331800085
ADMINISTRATOR:LACY,TORIFACILITY TYPE:
735
ADDRESS:1113 GARRETSON AVETELEPHONE:
(909) 437-5262
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY:6CENSUS: 4DATE:
07/03/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Charisse Mccoy- CEOTIME COMPLETED:
11:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not treat resident with respect
Staff do not allow resident to choose own clothing to wear
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Facility CEO Charisse Mccoy and explained the purpose of the visit. The investigation consisted of interviews, observations, and review of records.

Frist allegation: Staff do not treat resident with respect. Regarding the allegation stated above LPA conducted interviews with all clients pertaining to the allegation “Staff do not treat residents with respect” during the interview all four clients informed LPA that all staff treat them with respect and all clients informed LPA not witnessing staff mistreat or treat other clients with disrespect. In addition, four out of four clients informed LPA about feeling safe and enjoying where they live. LPA conducted an interview with Staff #1 who denied the allegation and informed LPA that all clients are treated with respect. In addition, S#1 also denied witnessing other staff mistreat or disrespect clients in care.

Second allegation: Staff do not allow resident to choose own clothing to wear. Regarding the allegation stated above LPA conducted interviews with clients pertaining to the allegation “Staff do not allow resident to choose own clothing to wear” during the interview four out of four residents informed LPA that they choose their own clothing and denied staff not allowing clients to choose their own clothes. All clients informed LPA that they dress themselves and choose what they want to wear. LPA conducted an interview with S#1 regarding the allegation stated above and S#1 denied not allowing clients to choose their own clothing. S#1 informed LPA that every clients chooses what they want to wear. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.
Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.
An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility CEO Charisse Mccoy at the end of the visit.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 56-AS-20250423123006
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MCCOY ADULT GROUP HOME
FACILITY NUMBER: 331800085
VISIT DATE: 07/03/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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24
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26
27
28
29
30
31
32
Regarding the allegation stated above LPA conducted interviews with clients pertaining to the allegation “Staff do not allow resident to choose own clothing to wear” during the interview four out of four residents informed LPA that they choose their own clothing and denied staff not allowing clients to choose their own clothes. All clients informed LPA that they dress themselves and choose what they want to wear. LPA conducted an interview with S#1 regarding the allegation stated above and S#1 denied not allowing clients to choose their own clothing. S#1 informed LPA that every clients chooses what they want to wear. Based on corroborating evidence obtained during the course of the investigation, LPA has determined that the above allegation is Unsubstantiated.

Unsubstantiated: meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility CEO Charisse Mccoy at the end of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5