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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880545
Report Date: 09/28/2023
Date Signed: 09/28/2023 12:42:08 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
06/28/2023 and conducted by Evaluator Javina George
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230628145601
FACILITY NAME:MAC'S HOME #1FACILITY NUMBER:
331880545
ADMINISTRATOR:PETERS, STEPHANIEFACILITY TYPE:
735
ADDRESS:887 ARIA RDTELEPHONE:
(909) 910-9114
CITY:HEMETSTATE: CAZIP CODE:
92543
CAPACITY:4CENSUS: 3DATE:
09/28/2023
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Solomon Chuwku, Administrator TIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility does not ensure staff are properly trained to dispense medications to clients in care
Staff does not ensure clients records are properly maintained
Staff do not dispense medications as prescribed to clients in care
Staff do not ensure clients are afforded the opportunity to attend community activities
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliever findings for the allegation(s) noted above. LPA met with Solomon Chukwu, Administrator and explained the purpose of the visit and the elements of the allegation(s). The allegation(s) were investigated, the investigation consisted of observations, interviews and records review.

Facility does not ensure staff are properly trained to dispense medications to clients in care
It was alleged that Staff #1 (S1) was not properly trained to administer medications, as they had assisted training another staff with administering medications when they had not been trained themselves. LPA conducted a review of S1’s file and observed for S1 to have completed their DSP training, including the medication administration training. It is important to note that S1’s file was believed to have been stolen, and the Licensee Mr. Lansdale Peters filed a police report due to the sensitive information contained in the staff file. The police report number is on file with the department and S1 was notified, as they are no longer working at the facility. Per the Licensee Mrs. Stephanie Peters, the only ***Continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
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 3
Control Number 18-AS-20230628145601
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: 09/28/2023
NARRATIVE
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individuals that have access to the staff files are the Administrator and Licensee’s, as they are the ones that hold the key. Interviews conducted with staff revealed that they do not have knowledge of staff not being properly trained and giving medication, but did hear that in the past staff were working by themselves and had no choice but to administer medication even if they were not properly trained to do so. Per those staff interviews it was reiterated that this was not something that was witnessed first hand but it was something that they heard. There is insufficient evidence to corroborate or refute the allegation of facility does not ensure staff are properly trained to dispense medications to clients in care, therefore it is UNSUBSTANTIATED.

Staff does not ensure clients records are properly maintained

It was alleged that the facility staff don't keep accurate P & I ledgers, as there are no ledgers or receipts for P& I, and that there were handwritten receipts with ineligible signatures. LPA conducted a review of two (2) clients P& I logs (Client #1 (C1) and Client #2 (C2), all money was balanced and accounted for, in addition the P&I ledgers and receipts were present and available for review for the months of July, August and September 2023. Note that Client #3 (C3) is able to handle their own money and there is no log kept for them. LPA did not observe any discrepancies. Per interviews conducted with the Administrator Solomon Chuwku, He is the one responsible for the P&I funds, and that the Licensee's do have access as well, outside out of the Licensee's and Administrator no one else has access to the clients P&I funds. LPA observed for there to be the actual use of P& I logs as well as there to be handwritten forms dating back to year 2018, however the only notes observed from the placing agency was reminding staff to have the resident cash out maintain a certain balance. Additionally it was reported On 4/28/2023 the Morning Notes for C3 were missing. The missing notes were located on the premises at the time of LPAs visit conducted on 7/5/23. It is unknown who took the notes out, but they were replaced. There is insufficient evidence to corroborate or refute the the allegation of staff does not ensure client records are properly maintained, therefore the allegation is UNSUBSTANTIATED.

Staff do not dispense medications as prescribed to clients in care. It was alleged that facility staff distributed medication to a resident’s that were expired and belonged to another resident. LPA was unable to corroborate that this incident did occur. It was further alleged that the Licensee gave the directive for staff to administer any residents that are prescribed a PRN medication for it to be given along with the regularly prescribed medication to assist with making the day running smoothly.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230628145601
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: 09/28/2023
NARRATIVE
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While it was confirmed that the Licensee Mrs. Stephanie Peters did give the directive, as a review of documentation confirmed what was alleged. A review of medication and Medical Authorization Record (MAR)s for C1, did not reveal that the directive was followed by facility staff as the PRN had not been given on a daily or consistent basis. The MARs revealed that the PRN was given one to three times a month. Based on interviews with facility staff, there was no knowledge of expired medications being administered, or a residents prescribed medication being given to another client. There is insufficient evidence to corroborate or refute the allegation of Staff do not dispense medications as prescribed to clients in care. Based on records review the allegation is UNSUBSTANTIATED.

Staff do not ensure clients are afforded the opportunity to attend community activities

It was alleged that the clients do not go on any outings, as the facility does not have a vehicle. A tour was inspected of the interior and exterior of the facility and LPA did not observe a facility vehicle nor any supporting documentation such as vehicle maintenance invoice. Per interviews with the Administrator Solomon Chuwku, the facility does not have a vehicle and has to share the vehicle that belongs to the sister facility with the home. It was reported during multiple staff interviews that normally the Administrator is the one that goes and makes the purchases for the clients, or sometimes the clients accompany the Administrator, but that has not happened since the Administrator that left back in May 2023.

Per interviews conducted with multiple facility staff revealed that on multiple occasions the expectation was facility staff were told to take their personal vehicles to transport the residents to their appointments, with being reimbursed $30 for gas, and other times were told to “figure it out”. Per the staff interviews conducted if staff are not willing to use their personal vehicles, then there are not any off grounds activities for the clients in care. A review of the facility’s activities calendars reviewed beginning March 2023 revealed that the only off ground activities were to go for a walk or go to a walk to the park.

Additionally, LPA conducted a review of the clients P& I logs. LPA observed receipts for the residents attending a movie at a local movie theater. Based on observations, interviews and records review the allegation is UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to Solomon Chukwu.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:

DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3