331880966-7-26-2023-18-AS-RSTS-CXF2GV-20231109162345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880966
Report Date: 07/26/2023
Date Signed: 07/26/2023 02:30:01 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/24/2023 and conducted by Evaluator Jesse Gardner

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230724085313

FACILITY NAME:	MAC'S HOME #2		FACILITY NUMBER:	331880966
ADMINISTRATOR:	PETERS, STEPHANIE		FACILITY TYPE:	735
ADDRESS:	7921 BRASS KETTLE CIRCLE		TELEPHONE:	(951) 213-2227
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92507
CAPACITY:	4	CENSUS: 3	DATE:	07/26/2023
		UNANNOUNCED	TIME BEGAN:	01:42 PM
MET WITH:	LaTonia Cannon, Caregiver		TIME COMPLETED:	02:43 PM

ALLEGATION(S):

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Staff speak inappropriately to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct an investigation into the above allegation. LPA arrived and met with Caregiver LaTonia Cannon and advised the purpose of the visit, and toured the facility.

It was alleged that staff yelled at Resident One (R1) and will tell R1 to "shut up" and "Be Quiet". R1 is reported to be non-verbal and will grunt and make sounds and that is why R1 was told to "shut up". Staff and resident interviews revealed that R1 is not mistreated, nor spoken to inappropriately, nor are other residents. Thus, this allegation was found to be Unsubstantiated. A finding of UNSUBSTANTIATED means 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 a copy of this report was discussed with and provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2023

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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