336410270-10-25-2023-18-AS-MVAO-CWZ243-20231026170315

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410270
Report Date: 10/25/2022
Date Signed: 10/25/2023 01:16:03 PM

Unfounded

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
03/20/2020 and conducted by Evaluator Venus Mixson

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200320165238

FACILITY NAME:	CHRISTMAS COTTAGE		FACILITY NUMBER:	336410270
ADMINISTRATOR:	VICTORIA J. SARSON		FACILITY TYPE:	740
ADDRESS:	330 S. SAN JACINTO ST		TELEPHONE:	(951) 765-1840
CITY:	HEMET	STATE: CA	ZIP CODE:	92543
CAPACITY:	14	CENSUS: 14	DATE:	10/25/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	ADMINISTRATOR, KAY HYLAND		TIME COMPLETED:	01:28 PM

ALLEGATION(S):

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Resident was unlawfully evicted while in care.

INVESTIGATION FINDINGS:

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On 10/25/2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator, Kay. The visit was conducted to provide the findings for the investigation pertaining to the listed allegation. During the investigation, LPA Mixson conducted interviews with the Administrator, Hospice Provider, and Witness.

On March 20, 2020, Community Care Licensing (CCL), received a complaint allegation alleging a resident was unlawfully evicted while in care.
It was reported that Resident #1 (R1) had behavioral issues, that were resolved, but the facility refused to accept the resident back in care. Information obtained from staff interviews and record reviews revealed R1 was receiving services from Manor Hospice. Additional information obtained advised the decision to place and remove the resident was decided through the Hospice agency, due to R1 requiring a higher level of care. It was advised that R1 was relocated and placed at the hospital. Information obtained from interviews with Administration, staff, and additional witnesses confirmed the information regarding the change of placement.

Based on interviews and record reviews, the information obtained does not corroborate the allegation. Therefore, the outcome of the listed allegation has been deemed as UNFOUNDED. An allegation finding of "Unfounded" means "the allegation is false, could not have happened and/or is without a reasonable basis." Therefore, the outcome of the allegation is deemed UNFOUNDED.

An exit interview was conducted and a copy of this report was provided to the Administrator Kay.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus Mixson	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2022

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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