336413141-4-11-2026-18-AS-RORN-DT5L38-20260414082332

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336413141
Report Date: 04/11/2026
Date Signed: 04/11/2026 10:26:56 AM

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
02/13/2024 and conducted by Evaluator Tena Herrera

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240213103416

FACILITY NAME:	SUPPORTING UNLIMITED POSSIBILITIES THE MACK HOUSE		FACILITY NUMBER:	336413141
ADMINISTRATOR:	DEBORAH STANGEL		FACILITY TYPE:	735
ADDRESS:	21800 MACK STREET		TELEPHONE:	(951) 780-3321
CITY:	PERRIS	STATE: CA	ZIP CODE:	92570
CAPACITY:	4	CENSUS: 4	DATE:	04/11/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Sandra Marinez - Caregiver		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Facility staff not being trained to do blood sugar checks.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tena Herrera conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with Caregiver Sandra Martinez and explained the purpose for todays visit, shortly after Facility Manager Brent Drouillard, arrived to assist with the visit.

The investigation consisted of the following:

LPA obtained copies of staff training for Blood Glucose level and Blood Pressure, Copy of Client #1 (C1) Records for Blood Sugars Tests/Blood Pressure Readings, and a copy of C1’s Diabetes Health Condition Care Plan, observed C1 getting assisted with checking their Blood Glucose level, and conducted interviews with 3 Staff (S1-S3) and 2 Clients (C2-C3).

(Continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2026

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-20240213103416

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: SUPPORTING UNLIMITED POSSIBILITIES THE MACK HOUSE	FACILITY NUMBER: 336413141
	VISIT DATE: 04/11/2026

NARRATIVE

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Allegation: Facility staff not being trained to do blood sugar checks

It is alleged that staff have not received training to conduct blood glucose testing for C1 who is disabled and cannot conduct their own blood glucose tests. LPA obtained copy of staff training for Blood Glucose level and Blood Pressure, training was conducted by a Registered Nurse on 2/23/24. LPA obtained a copy of documented record for C1’s Blood Sugar Tests and Blood Pressure Readings from 2/13/26 – 4/11/26, there were no missed tests/readings observed. LPA obtained a copy of C1’s most recent Diabetes Health Condition Care Plan (dated 9/19/25) that states tests are to be conducted in the AM with staff supervision and assistance. LPA observed client being assisted with their blood sugar check at 8:42am, client was able to grab the device that holds the needle themselves and puncture their finger then grab the other device that the blood is placed in and place on the spot of blood drawn for the reading, S1 assisted the client only and did not puncture the C1 with the needle, staff was wearing gloves and used alcohol wipes and properly disposed of all items. LPA interviewed 2 Clients, the 2 clients interviewed do not take any medications that require injection or need blood glucose testing, however, both stated that they are assisted with medication and take it themselves. LPA was not able to interview with C1 as C1 is hard of hearing and LPA was having difficulty communicating, however, the LPA was able to observe C1 being assisted with their Blood Glucose test during visit. LPA interviewed 3 staff and each denied the above allegation and stated that all staff has been trained on assisting the clients with medication and Blood Sugars Tests/Blood Pressure Readings.

Based on statements and interviews conducted with staff & clients, and review of facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview held, and a copy of this report was provided.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Tena Herrera
LICENSING EVALUATOR SIGNATURE:	DATE: 04/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2026

LIC9099 (FAS) - (06/04)

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