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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800088
Report Date: 06/17/2022
Date Signed: 06/17/2022 03:00:38 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/21/2022 and conducted by Evaluator Jennifer Semin
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20220321125154
FACILITY NAME:STEWART'S RESIDENTIAL CAREFACILITY NUMBER:
331800088
ADMINISTRATOR:STEWART, REUBENFACILITY TYPE:
735
ADDRESS:3631 MARI DRIVETELEPHONE:
(562) 682-0946
CITY:LAKE ELSINORESTATE: CAZIP CODE:
92530
CAPACITY:4CENSUS: 4DATE:
06/17/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Maureen Sevilla, Facility ManagerTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff smokes in the presence of clients.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Jennifer Semin conducted an unannounced visit to deliver the findings for the above complaint allegation. LPA met with House Manager, Maureen Sevilla.

The investigation consisted of interviews with staff and clients. Regarding the allegation, staff smokes in the presence of clients. All staff interviewed stated no one employed or residing at this facility smoke. Client 1 - Client 3 all denied smoking and have never seen any staff smoking at the facility. Client 4 would not corroborate or refute the allegation.

Based upon interviews and information gathered, and 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, therefore the allegation are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report was discussed and provided to Ms. Sevilla.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE:

DATE: 06/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2022
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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