336425056-12-12-2023-56-AS-EMAN-D3HT7J-20240319142850

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336425056
Report Date: 12/12/2023
Date Signed: 12/12/2023 02:23:16 PM

Unsubstantiated

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
12/08/2023 and conducted by Evaluator Mary Rico

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231208143330

FACILITY NAME:	MANITOBA RESIDENTIAL CARE		FACILITY NUMBER:	336425056
ADMINISTRATOR:	CHARISSE MCCOY		FACILITY TYPE:	735
ADDRESS:	1703 MANITOBA CIRCLE		TELEPHONE:	(951) 531-8952
CITY:	CORONA	STATE: CA	ZIP CODE:	92882
CAPACITY:	5	CENSUS: 4	DATE:	12/12/2023
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Charisse Mccoy		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff do not allow clients to call family.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Adminstrator Charisse Mccoy Mccoy and explained the purpose of the visit. The investigation consisted of staff interviews, clients’ interviews, and facility tour.

For allegation, Staff do not allow clients to call family.

During interviews with clients, all clients stated they are allowed to call family members. S1 informed LPA they are allowed to use the facility phone or thier personal cell phone to call their family members.S2 demonstrated they can call their family.

During interviews with staff, all staff stated the clients are allowed to call their family members and have access to facility phone when needed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

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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Control Number 56-AS-20231208143330

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: MANITOBA RESIDENTIAL CARE	FACILITY NUMBER: 336425056
	VISIT DATE: 12/12/2023

NARRATIVE

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Based on the evidence found during the investigation, the one (1) allegation listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Charisse Mccoy.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE:	DATE: 12/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/12/2023

LIC9099 (FAS) - (06/04)

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