336426470-11-10-2021-18-AS-JDHS-CLAPVN-20221118103922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426470
Report Date: 11/10/2021
Date Signed: 11/10/2021 10:50:23 AM

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
05/29/2020 and conducted by Evaluator Yolanda Delgado

COMPLAINT CONTROL NUMBER: 18-AS-20200529135656

FACILITY NAME:	ATTENTIVE MANOR		FACILITY NUMBER:	336426470
ADMINISTRATOR:	MATTHEW SIEGEL		FACILITY TYPE:	740
ADDRESS:	66-338 FOURTH ST.		TELEPHONE:	(760) 251-4330
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY:	6	CENSUS: 0	DATE:	11/10/2021
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Matthew Siegel, Administrator		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Facility staff do not have required TB clearance.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yolanda Delgado arrived at the facility to conclude a complaint investigation into the allegation noted above. LPA toured the facility and there are no residents and staff at the facility. LPA met with Administrator (AD) Matthew Siegel. During the investigation LPA reviewed ten (10) staff files and there were ten (10) TB clearances for staff working during the time frame of the complaint. LPA was also unable to find any evidence that the facility hired someone with no TB clearance. Administrator denies the S1 ever worked at the facility, states “the person had a pre-interview but never worked at the facility, the person stated "he did not have legal documents.". The above allegation is found to be UNSUBSTANTIATED. 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 at this time.
An exit interview was conducted with Administrator Siegel and a copy of this report was provided

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Yolanda Delgado	TELEPHONE: (951) 203-0337
LICENSING EVALUATOR SIGNATURE:	DATE: 11/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021

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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