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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800085
Report Date: 07/03/2025
Date Signed: 07/03/2025 11:29:42 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
03/06/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250306163141
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:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff speaks to resident in an inappropriate manner.
Staff did not provide transportation to resident.
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: Staff speaks to resident in an inappropriate manner. Regarding the allegation stated above LPA conducted interviews with four clients pertaining to the allegation “Staff speaks to resident in an inappropriate manner” during the interview all four clients denied the allegation and informed LPA that staff treats clients with respect and does not speak to clients in an inappropriate manner. In addition, four out of four residents denied witnessing staff speak to clients in an inappropriate manner. LPA conducted an interview with Staff #1 regarding the allegation stated above S#1 denied the allegation and informed LPA not witnessing staff speak to clients in an inappropriate manner.
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 2
Control Number 56-AS-20250306163141
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
23
24
25
26
27
28
29
30
31
32
Second allegation: Staff did not provide transportation to resident. Regarding the allegation LPA conducted an interview with facility administrator pertaining to the allegation stated above during the interview administrator informed LPA that client’s transportation to Day Program is not a service that is solicited by the facility but rather through Inland Regional Center. Administrator further explained that client was having a behavior and at the time SVS was not able to transport due to C#1 behavior. Administrator explained to SVS that they are not vendorized for transportation. However, Administrator later informed LPA that transportation services were able to drop off client after program. Administrator informed LPA that facility provides transportation services to clients for medical and dental however, they are not solicited to provide transportation to Day Programs. 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: 2 of 2