336412239-8-11-2023-18-AS-JDHS-D36NCU-20240308092112

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336412239
Report Date: 08/11/2023
Date Signed: 08/11/2023 04:18:32 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
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

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20221214110031

FACILITY NAME:	AGAPE CARE HOME RIVERSIDE		FACILITY NUMBER:	336412239
ADMINISTRATOR:	DARYL LEE		FACILITY TYPE:	740
ADDRESS:	5715 RIVERSIDE AVENUE		TELEPHONE:	(951) 682-1389
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92506
CAPACITY:	6	CENSUS: 6	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	03:47 PM
MET WITH:	ADMINISTRATOR, DARYL LEE		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is not clean.

INVESTIGATION FINDINGS:

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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 is not clean, the information obtained from interviews and the record review did not reveal enough information to demonstrate the listed allegation. The staff and resident interviews, and the observations, does not corroborate the listed allegation.

Based on interviews and observations the allegation finding has been deemed "UNSUBSTANTIATED." An allegation finding of "unsubstantiated" means, "although, the allegation may have happened or is valid, there is not a preponderance of the evidence strand to prove the alleged violations did or did not occur." Therefore, the allegations are deemed "unsubstantiated."

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

Unsubstantiated

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: 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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