331881130-12-21-2021-18-AS-JESL-CETVWB-20220527164739

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881130
Report Date: 12/21/2021
Date Signed: 12/21/2021 12:08:02 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
11/18/2021 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20211118103143

FACILITY NAME:	C & M COMFORT HOME		FACILITY NUMBER:	331881130
ADMINISTRATOR:	COURT, CHRISTIAN		FACILITY TYPE:	735
ADDRESS:	24662 MANTEE PLACE		TELEPHONE:	(951) 378-5820
CITY:	MORENO VALLEY	STATE: CA	ZIP CODE:	92553
CAPACITY:	6	CENSUS: 5	DATE:	12/21/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Cecila Egbune, Caregiver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff manipulated client into doing things they do not want to do.
Staff did not inform clients authorized representative of changes to resident's care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George arrived at the facility unannounced to deliver findings for the allegation(s) listed above. LPA met with Cecila Egbune, Caregiver and explained the purpose of the visit and element of the allegation(s). Administrator Christian was available via telephone, as he was out shopping with the residents at the time of LPAs visit. The department's complaint investigation consisted of observation, interviews and record review.

Allegation: Staff manipulated client into doing things they do not want to do.
LPA interviewed Resident #1 (R1) whom stated that there were things that they wanted to do such as to have a new Doctor from Kaiser, and to move back home with their Father. R1 stated that they did discuss with the Administrator what steps should be taken. R1 denied that staff had them do things against their will. R1 was observed to not be anxious, gave eye contact, and did not hesitate to answer LPAs questions. There is not enough evidence to corroborate the allegation. Therefore the allegation of Staff manipulated client into doing things they do not want to do is UNSUBSTANTIATED.

***Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

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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Control Number 18-AS-20211118103143

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: C & M COMFORT HOME	FACILITY NUMBER: 331881130
	VISIT DATE: 12/21/2021

NARRATIVE

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Allegation: Staff did not inform clients authorized representative of changes to resident's care.

LPA interviewed Administrator Christian Court whom denied the allegation, as there have not been any changes to R1s care. Christian explained that R1 continues to have a lot of changes with their case from the mental health clinic. Christian stated that R1s Case Manager has changed multiple times due to a high turnover rate. When it comes to R1 no longer being under conservatorship, that is something that happened back in 2015, and did not feel that was something that should be communicated as it would be known reviewing R1s file. Christian stated that there was a discussion of R1 wanting to change their Doctor as well as payee, but the discussion was with R1s treatment team. There is not enough evidence to support the allegation of Staff did not inform clients authorized representative of changes to resident's care, therefore the claim 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, and a copy of this report was provided to Cecila Egbune, Caregiver,

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021

LIC9099 (FAS) - (06/04)

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