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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336425055
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:53:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
09/12/2024 and conducted by Evaluator Mary Rico
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240912202512
FACILITY NAME:MOQUETE FAMILY HOME, THEFACILITY NUMBER:
336425055
ADMINISTRATOR:MOQUETE, NANCYFACILITY TYPE:
735
ADDRESS:7976 POPPY ST.TELEPHONE:
(951) 817-2556
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY:6CENSUS: 4DATE:
09/26/2024
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator - Marcela's Hurtado TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff provide food that is of poor quality to residents.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Mary Rico and Raquel Hernandez conducted an unannounced visit to deliver findings on the allegation listed above. LPAs met with Administrator Marcela Hurtado, and explained the purpose of the visit. The investigation consisted of staff interviews, client interviews and facility tour.

For the allegation, Facility staff provide food that is of poor quality to residents.

LPA Rico conducted two (2) staff interviews and (4) four client interviews.

During client interviews 1 out of the 4 clients stated they were unable to eat their meal at Day Program because their sandwich had mole and green spots. During staff interviews, S1 stated they had prepare C1's sandwich for Day Porgram. S1 informed LPA they did not notice the sandwich had mole and green spots before leaving to Day Program.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 56-AS-20240912202512
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MOQUETE FAMILY HOME, THE
FACILITY NUMBER: 336425055
VISIT DATE: 09/26/2024
NARRATIVE
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On September 17, 2024 LPA Rico and LPA Hernandez inspected 4 clients lunch meal bags. 1 out of the 4 clients had a rotten apple inside their lunch bag. In addition, S1 immediately discard the rotten apple and stated they did not notice the rotten apple. The lunch meal was prepared a day in advance for Day Program.

Based on the evidence gathered during today’s investigation, the one (1) allegation listed above are deemed SUBSTANTIATED. A finding that the complaints are SUBSTANTIATED means that the allegation are valid because the preponderance of evidence the standard has been met.

During today’s visit, one (1) deficiency were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC9099) and LIC9099D was discussed and provided to Administrator Marcela Hurtado along with a copy of the appeal rights.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240912202512
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MOQUETE FAMILY HOME, THE
FACILITY NUMBER: 336425055
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2024
Section Cited
CCR
80076(a)(1)
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80076(a)(1)Food Services
(a) In facilities providing meals to clients, the following .(1)All food shall be safe and of the quality necessary to meet the.. of the clients... All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Licensee stated to train all staff on CCR 80076(a)(1) and submit proof of all staff training log to LPA Rico by Plan of Correction (POC) due date.
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Based on observation and interview the licensee did not comply with the section cited above evidenced by not ensuring food is prepare and served in a safe manner, which poses a potential health, saftey and personal rights risk to residents in care.
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POC due date 10/3/2024
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3