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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 335530052
Report Date: 01/27/2025
Date Signed: 01/27/2025 03:40:19 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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2025 and conducted by Evaluator Bernadette Allen
COMPLAINT CONTROL NUMBER: 56-AS-20250123155748
FACILITY NAME:MESA POINTE HOMEFACILITY NUMBER:
335530052
ADMINISTRATOR:CARMEN D. WYDERMYREFACILITY TYPE:
735
ADDRESS:171 TRADITION COURTTELEPHONE:
(951) 452-4565
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:4CENSUS: 4DATE:
01/27/2025
UNANNOUNCEDTIME BEGAN:
02:46 PM
MET WITH:Gloria Thomas Licensee TIME COMPLETED:
03:50 PM
ALLEGATION(S):
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Staff leaves residents unsupervised for extended periods of time.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bernadette Allen made an unannounced visit to the facility to commence a complaint investigation and deliver findings. LPA identified herself and discussed the purpose of the visit with Gloria Thomas Licensee.

The investigation consisted of interviews with staff members and the licensee, who confirmed that a staff member left clients unsupervised for an extended period. The licensee also stated that disciplinary actions, precautions, and training have been implemented to ensure clients in care are never left unsupervised in the future. A citation issued for leaving clients unsupervised which poses an immediate health, safety or personal rights risk to persons in care.

Based on the evidence gathered during the investigation, the above allegation is found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
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 3
Control Number 56-AS-20250123155748
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
, CA 92507

FACILITY NAME: MESA POINTE HOME
FACILITY NUMBER: 335530052
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2025
Section Cited
CCR
80078(a)
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Responsibility for Providing Care and Supervision

(a) The licensee shall provide care and supervision as necessary to meet the client's needs. This requirement was not met as evidenced by:
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The licensee has agreed to provide training on the cited regulation and provide a statmente of understanding of the regulation singed by all staff members by the POC date of 1/28/2025.
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During the investigation the licensee and staff stated cleints were left at the barber shop unsupervised which poses an immediate health, safety or personal rights risk to persons 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: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 56-AS-20250123155748
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
, CA 92507
FACILITY NAME: MESA POINTE HOME
FACILITY NUMBER: 335530052
VISIT DATE: 01/27/2025
NARRATIVE
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An exit interview was conducted where this report LIC9099, 9099-C and 9099-D was discussed and provided to Gloria Thomas- Administrator at the conclusion of the visit with appeal rights.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3