336426745-9-27-2024-18-AS-JDHS-D9MLAU-20241001083540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336426745
Report Date: 09/27/2024
Date Signed: 09/27/2024 09:44:13 AM

Substantiated

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
04/13/2021 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20210413100157

FACILITY NAME:	MATTHIAS HOME		FACILITY NUMBER:	336426745
ADMINISTRATOR:	JAMES TOLAND		FACILITY TYPE:	735
ADDRESS:	13801 MOUNTAIN TOP DRIVE		TELEPHONE:	(760) 671-7421
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY:	6	CENSUS: 6	DATE:	09/27/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Alexis Parker		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is lacking food for the clients in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Alexis Parker and explained the purpose of the visit and the elements of the allegation. The investigation consisted of observation, interviews with staff members and residents, and records review.
On 04/13/2021, Community Care Licensing received a complaint alleging facility is lacking food for the clients in care. It was alleged that there was not enough adequate food available for the residents to eat. During the initial interviews conducted in 2021, it was revealed that staff had to purchase food for the residents with their own monies due to there not being enough food for the clients.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

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 5

Control Number 18-AS-20210413100157

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: MATTHIAS HOME	FACILITY NUMBER: 336426745
	VISIT DATE: 09/27/2024

NARRATIVE

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It was revealed that the company card that was used to purchase food declined the charges on separate occasions. Information obtained from interviews with staff stated that Licensees encouraged staff to buy alternate foods that residents may not like in order for residents to not consume so much food. Additional interviews also indicated that the food the residents were consuming were not listed on the food menu due to not having the food items available and the budget for food decreased. On May 2021, the RO was able to observe the facility to have sufficient food, but this was after the complaint was initiated.
Based on LPA’s observations, interviews, and record reviews, it was deemed that the facility did lack the necessary food for the residents in care and the preponderance of evidence standard has been met; therefore, the above allegation is SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 6 85076(d)(1)), are being cited on the attached LIC 9099D. An exit interview was conducted, a copy of this report, along with the 9099-D, and appeal rights were discussed and provided to Administrator, Alexis Parker.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 18-AS-20210413100157

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: MATTHIAS HOME	FACILITY NUMBER: 336426745
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/27/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/24/2024 Section Cited HSC 85076(d)(1)	1 2 3 4 5 6 7	85076 (d) The licensee shall meet the following food supply and storage requirements: (1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	The plan of correction was cleared on 09/24/2024 based on food supply LPA observed on 07/24/2024 in addition to pictures submited on 05/14/2021.
	8 9 10 11 12 13 14	Based on the LPA's observation, interviews and record review, the licensee did not comply with the section cited above by allowing food supplies to get low, which poses an immediate health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5

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
04/13/2021 and conducted by Evaluator Kathleen Banrasavong

COMPLAINT CONTROL NUMBER: 18-AS-20210413100157

FACILITY NAME:	MATTHIAS HOME		FACILITY NUMBER:	336426745
ADMINISTRATOR:	JAMES TOLAND		FACILITY TYPE:	735
ADDRESS:	13801 MOUNTAIN TOP DRIVE		TELEPHONE:	(760) 671-7421
CITY:	DESERT HOT SPRINGS	STATE: CA	ZIP CODE:	92240
CAPACITY:	6	CENSUS: 6	DATE:	09/27/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Administrator, Alexis Parker		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility is lacking the resources to operate

INVESTIGATION FINDINGS:

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Licensing Program Analyst, (LPA) Kathleen Banrasavong conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA met with Administrator, Alexis Parker and explained the purpose of the visit and the elements of the allegation. The investigation consisted of observation, interviews with staff members and residents, and records review.
On 04/13/2021, Community Care Licensing received a complaint alleging facility is lacking the resources to operate. It was alleged that the facility was lacking the necessary funds to pay staff members. It was reported that staff were attempting to cash their payroll checks and the checks would “bounce.” Information obtained from current Administrator indicated that there were no issues with solvency.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 18-AS-20210413100157

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: MATTHIAS HOME	FACILITY NUMBER: 336426745
	VISIT DATE: 09/27/2024

NARRATIVE

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The initial LPA was unable to obtain an interview the initial Administrator. During interviews with staff, it was also indicated that the staff were being paid late. Information obtained from interviews with additional staff indicated that they had no issues or concerns with cashing their checks or being paid on time. LPA was unable to corroborate this allegation through record reviews due to the amount of time that passed from when the complaint was initiated. LPA was also unable to obtain additional information from pertinent parties due to not being able to obtain contact.

Based on observation, interviews, and the inability to review records, this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur; therefore, the allegation is unsubstantiated.
An exit interview was conducted and a copy of this report was discussed and provided to Administrator, Alexis Parker.

SUPERVISOR'S NAME: Jazmond D Harris	TELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Kathleen Banrasavong	TELEPHONE: 951-622-3619
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5