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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336412341
Report Date: 10/31/2022
Date Signed: 10/31/2022 09:46:13 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
03/25/2021 and conducted by Evaluator Natalie Ibarra
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210325095525
FACILITY NAME:MAYBERRY HOUSE, THEFACILITY NUMBER:
336412341
ADMINISTRATOR:DEBORAH STANGELFACILITY TYPE:
735
ADDRESS:40678 MAYBERRY AVETELEPHONE:
(951) 652-3556
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:4CENSUS: 3DATE:
10/31/2022
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Veda HerveyTIME COMPLETED:
09:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Personal rights
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Natalie Ibarra and Paola Guerrero conducted an unannounced visit to the facility to deliver findings for the above allegation. LPA met with House Manager Veda Hervey and explained the purpose of today’s visit. The investigation consisted of interviews with pertinent parties.
The allegation indicates personal rights. Interviews with Staff #3 (S3), Staff #4 (S5), Staff #5 (S5), and Staff #6 (S6) stated they have never witness Staff #2 (S2) push Client #1 (C1) aggressively nor any other clients in care. S4 and S5 stated S2 was great with C1. LPAs interviewed Consumer Program Liaison with Inland Regional Center (IRC) who stated IRC was unable to substantiate allegations due to there not being enough evidence.
Based on the information obtained, the allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.
No deficiencies were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to House Manager Veda Hervey.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Natalie Ibarra
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022
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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