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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412239
Report Date: 08/11/2023
Date Signed: 08/11/2023 03:29:29 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
12/14/2022 and conducted by Evaluator Venus Mixson
COMPLAINT CONTROL NUMBER: 18-AS-20221214110031
FACILITY NAME:AGAPE CARE HOME RIVERSIDEFACILITY NUMBER:
336412239
ADMINISTRATOR:DARYL LEEFACILITY TYPE:
740
ADDRESS:5715 RIVERSIDE AVENUETELEPHONE:
(951) 682-1389
CITY:RIVERSIDESTATE: CAZIP CODE:
92506
CAPACITY:6CENSUS: 6DATE:
08/11/2023
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:ADMINISTRATOR, DARYL LEETIME COMPLETED:
03:29 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not being paid by Licensee.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On August 11, 2023, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with the Administrator. The visit was conducted in order to provide the findings for the investigation pertaining to the listed allegation. During the investigation, LPA Mixson conducted interviews with the Licensee, the Administrator, and staff and residents.

On December 14, 2022, Community Care Licensing (CCL), received information stating the facility staff are not being paid by the Licensee.

Regarding the allegation, the facility staff are not being paid by the Licensee, the information obtained from interviews and the record review, revealed the facility staff have been paid. The interviews and the record review does not corroborate the listed allegation.

Based on interviews, record reviews, and observations the allegation finding has been deemed "Unfounded." An allegation finding of "unfounded," means the allegation was without merit or is false and could not have happened and/or is without a reasonable basis.

An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to the Administrator, Daryl Lee.




Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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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