336402994-8-2-2022-56-AS-KCLS-CKHPV4-20221024113827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336402994
Report Date: 08/02/2022
Date Signed: 08/02/2022 03:21:46 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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/28/2022 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220728150851

FACILITY NAME:	LIFESTYLE HOME CARE		FACILITY NUMBER:	336402994
ADMINISTRATOR:	MARY MATEAS		FACILITY TYPE:	740
ADDRESS:	5377 CAROL WAY		TELEPHONE:	(951) 684-5833
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92509
CAPACITY:	6	CENSUS: 3	DATE:	08/02/2022
		UNANNOUNCED	TIME BEGAN:	01:55 PM
MET WITH:	Mary Mateas, Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Misuse of resident's funds

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding an allegation of misuse of resident's funds. LPA Prieto met with Administrator Mary Mateas and discussed the elements of the allegations. LPA Prieto obtained documentation from Mary Mateas regarding resident #1 (R1) in question. Documentation will show that R1 has a separate payee that is not the administrator of the facility or association to the facility. R1 receives financial benefits directly toward R1's payee. Documentation gathered, related towards the facility, are those related to rent and finances related to R1s stay at the facility. R1 is handling their own financial matter through outside agencies and to the placement agency party.

Based on the information obtained there is not enough evidence that facility misuses resident's funds. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 08/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/02/2022

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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