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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331800174
Report Date: 05/07/2025
Date Signed: 05/07/2025 02:14:52 PM

Substantiated


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
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/07/2021 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210107170535
FACILITY NAME:DAVIS CARE SERVICES INCFACILITY NUMBER:
331800174
ADMINISTRATOR:MCCOY JR, WILLIAMFACILITY TYPE:
735
ADDRESS:40927 BELLERAY AVETELEPHONE:
(951) 239-0996
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:4CENSUS: 0DATE:
05/07/2025
ANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chris Davis, Licensee/AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff not allowing resident to enter the facility.
Staff threatened resident.
INVESTIGATION FINDINGS:
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On 05/07/2025 at 01:00 PM, Licensing Program Analysts (LPAs) Melody Brown and Antoinette Davis met with Licensee/Administrator Chris Davis at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office (RO) to deliver the findings of the above allegations. LPAs Brown and Davis explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentation.

First allegation: Staff not allowing resident to enter the facility. The investigation was conducted by LPAs Debbie Mullen, Yolanda Delgado and Melody Brown. The investigation consisted of observation and interviews with relevant parties. The first allegation indicates that Staff not allowing resident to enter the facility. During the investigation, LPAs Mullen, Delgado and Brown were able to obtain sufficient evidence to corroborate that staff not allowing resident to enter the facility. Interview with Client #1 (C1) indicated that a staff at the facility did not allow C1 to enter the facility on 12/2020 after C1's work and C1 had to wait outside the facility for almost two (2) hours to gain access at the home. ***Continuation in LIC9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 18-AS-20210107170535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DAVIS CARE SERVICES INC
FACILITY NUMBER: 331800174
VISIT DATE: 05/07/2025
NARRATIVE
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In addition, C1 shared that it was cold that time and when a staff opened the door at the facility, C1 immediately enter the facility and proceeded to C1's room. Moreover, interview with Client #2 indicated that if C1 did not check in, staff will not let C1 in at the facility. Also, Staff #2 (S2) reported that Staff #1 (S1) told them not to allow C1 to enter the facility on 12/2020, but S2 stated that S2 still allowed C1 to enter the facility as it is not right to not allow C1 access to the facility.

Second allegation: Staff threatened resident. The investigation was conducted by LPAs Debbie Mullen, Yolanda Delgado and Melody Brown which consisted of observation and interviews with relevant parties. During the investigation, LPAs Mullen, Delgado and Brown were able to obtain sufficient evidence to support that staff threatened resident. Interview with C1 indicated that Staff #3 (S3) shouted at C1 and C1 added that S3 said that S3 has a family member that's in a gang that will deal with C1. Interview with S2 revealed that S2 was working at the facility and talking to C1 in C1s room when S3 shouted, screamed and used foul language to C1 and S2 confirmed hearing that S3 threatened C1 that S3 has a family member that's in a gang that will deal with C1. In addition. S2 shared that S2 was able to redirect S3 and S3 went downstairs of the facility. Records review indicated that S3 was terminated on 12/18/2020 for being verbally aggressive with C1.

Based on LPAs Mullen, Delgado and Brown’s interview, the preponderance of evidence standard has been met, and therefore the allegation of staff not allowing resident to enter the facility (Allegation #1), and staff threatened resident (Allegation #2) are found to be SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegation of staff not allowing resident to enter the facility (Allegation #1), and staff threatened resident (Allegation #2) are valid because the preponderance of the evidence standard has been met. California Code of Regulations, (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC9099D.

An exit interview was conducted where this report (LIC9099), LIC9099D and Appeal Rights were discussed and provided to Licensee/Administrator Chris Davis.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 18-AS-20210107170535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: DAVIS CARE SERVICES INC
FACILITY NUMBER: 331800174
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/16/2025
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights...(3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter...This requirement is not met as evidenced by:

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Licensee stated to train all staff on CCR 80072(a)(3) and submit proof to LPA Brown by the Plan of Correction (POC) due date.
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Based on interview, the Licensee did not comply with the section cited above by not allowing Client #1 (C1) to enter the facility and C1 had to wait for about two (2) hours outside the facility in a cold weather which poses a potential health, safety and personal rights risk to client in care.
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Type B
05/16/2025
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs. This requirement is not met as evidenced by:
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Licensee stated that S3 was terminated on 12/18/2020. Also, Licensee agreed to train all staff on CCR 80065(a) and submit proof to LPA Brown by the Plan of Correction (POC) due date.
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Based on interview, the Licensee did not comply with the section cited above by not ensuring that Staff #3 (S3) was competent to provide services to meet C1's needs and not to threaten C1 and be verbally aggressive as well which poses a potential health, safety and personal rights risk to resident 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: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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
CCLD Regional Office, 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
01/07/2021 and conducted by Evaluator Melody Brown
COMPLAINT CONTROL NUMBER: 18-AS-20210107170535

FACILITY NAME:DAVIS CARE SERVICES INCFACILITY NUMBER:
331800174
ADMINISTRATOR:MCCOY JR, WILLIAMFACILITY TYPE:
735
ADDRESS:40927 BELLERAY AVETELEPHONE:
(951) 239-0996
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:4CENSUS: 0DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Chris Davis, Licensee/AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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2
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Staff made a false report about resident to law enforcement.
INVESTIGATION FINDINGS:
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On 05/07/2025 at 01:00 PM, Licensing Program Analysts (LPAs) Melody Brown and Antoinette Davis met with Licensee/Administrator Chris Davis at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office (RO) to deliver the findings of the above allegation. LPAs Brown and Davis explained the purpose of the requested Office Visit. The investigation consisted of observation, interviews and a review of pertinent documentation.

The investigation was conducted by LPAs Debbie Mullen, Yolanda Delgado and Melody Brown. The investigation consisted of records review and interviews with relevant parties. The allegation indicates that staff made a false report about resident to law enforcement. During the investigation, LPAs Mullen, Delgado and Brown were not able to obtain sufficient evidence to corroborate the allegation. Local law enforcement staff informed LPA Delgado that per their department records review, no service calls and no police reports generated at the facility with Client #1 (C1) involved. ***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 18-AS-20210107170535
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DAVIS CARE SERVICES INC
FACILITY NUMBER: 331800174
VISIT DATE: 05/07/2025
NARRATIVE
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Therefore, based on the evidence obtained during LPAs Mullen, Delgado and Brown's investigation, there is insufficient evidence to prove that staff made a false report about resident to law enforcement is UNSUBSTANTIATED at this time. Although the allegation of staff made a false report about resident to law enforcement 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 allegations are UNSUBSTANTIATED at this time.

An exit interview was conducted where this report (LIC9099), was discussed and provided to Licensee/Administrator Chris Davis.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5