331880545-4-20-2023-18-AS-EMAN-CRUKQC-20230515080608

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880545
Report Date: 04/20/2023
Date Signed: 04/20/2023 01:12:11 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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/01/2021 and conducted by Evaluator Melody Brown

COMPLAINT CONTROL NUMBER: 18-AS-20210401105538

FACILITY NAME:	MAC'S HOME #1		FACILITY NUMBER:	331880545
ADMINISTRATOR:	PETERS, STEPHANIE		FACILITY TYPE:	735
ADDRESS:	887 ARIA RD		TELEPHONE:	(909) 910-9114
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	4	CENSUS: 4	DATE:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Direct Service Professional II Felicia Masters		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff not trained to administer medications.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility 04/20/2023 at 9:45 AM to initiate a complaint investigation. LPA Brown was greeted and granted entrance to the facility by Direct Service Professional (DSP) II Felicia Masters and Licensee/Administrator Stephanie Peters was contacted and informed of the visit but unable to go to the facility for personal reasons. LPA Brown explained the purpose of the visit to DSP II Masters and Licensee/Administrator Peters.

The investigation was conducted by LPA Melody Brown. The investigation consisted of observations, records review and interviews with relevant parties. The allegation indicates that Facility staff not trained to administer medications. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with staffs indicated that the facility's providing on- the- job medication training to new hire staffs in addition to Direct Service Professional (DSP) Training which includes medication training that’s a required training to all new hired staffs.
***Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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 18-AS-20210401105538

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: MAC'S HOME #1	FACILITY NUMBER: 331880545
	VISIT DATE: 04/20/2023

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

Residents’ interviews revealed no incident happened at the facility that their medication were not given on time, or in error and that staffs are always giving their medication regularly and on time. During the visit, LPA Brown reviewed clients’ Medication Administration Records (MAR) and all MARs were updated by staffs.

Based on the evidence, the allegation that Facility staff not trained to administer medications is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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 is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Direct Service Professional II Felicia Masters.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2