336410270-7-24-2024-18-AS-JDHS-D7PMDR-20240731093136

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336410270
Report Date: 07/24/2024
Date Signed: 07/24/2024 02:13:32 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
01/15/2021 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20210115160803

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: 11	DATE:	07/24/2024
		UNANNOUNCED	TIME BEGAN:	12:58 PM
MET WITH:	Supervisor, Kailene Martinez		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility failed to provide adequate food service

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegations. LPA met with Supervisor, Kailene Martinez and LPA explained the purpose of the visit and the elements of the allegations. The investigation consisted of observation, interviews with staff members and residents, and records review. LPA was unable to interview all pertinent parties in order to obtain further information.

On 01/15/2021, Community Care Licensing received a complaint alleging that facility staff failed to provide adequate food service. It was reported that the facility was portioning the food too small. It was also reported that the food was locked in the storage room. LPA conducted an interview with the Administrator, Kay Hyland who stated that the facility provides adequate food and water for the residents’ meals time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

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-20210115160803

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: CHRISTMAS COTTAGE	FACILITY NUMBER: 336410270
	VISIT DATE: 07/24/2024

NARRATIVE

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Administrator stated the facility has plenty of food for residents and staff. Administrator advised the Head Chef, Nisha Diaz places orders on a system to get the food delivered every Tuesday and Friday. LPA interviewed Head Chef who corroborated the information advised and added that if additional items are needed, staff purchase items at the store. LPA also interviewed staff members and residents who were employed and placed at the facility from 2021, who stated that the facility has always provided adequate meals for the residents. LPA observed the refrigerator, freezer, pantry, and food storage and there were no concerns present that violated regulation standards. No concerns were advised.

Based on LPA’s observation, interviews conducted, and record review, the allegations that facility failed to provide adequate food service isunsubstantiated due to the inability to interview pertinent parties. A finding of unsubstantiated means the allegations may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was discussed with and provided to the Supervisor, Kailene Martinez.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024

LIC9099 (FAS) - (06/04)

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