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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336426745
Report Date: 12/04/2023
Date Signed: 12/04/2023 10:57:49 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
11/18/2020 and conducted by Evaluator Jesse Gardner
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201118094923
FACILITY NAME:MATTHIAS HOMEFACILITY NUMBER:
336426745
ADMINISTRATOR:JAMES TOLANDFACILITY TYPE:
735
ADDRESS:13801 MOUNTAIN TOP DRIVETELEPHONE:
(760) 671-7421
CITY:DESERT HOT SPRINGSSTATE: CAZIP CODE:
92240
CAPACITY:6CENSUS: 5DATE:
12/04/2023
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Alexis Parker, Lead StaffTIME COMPLETED:
11:07 AM
ALLEGATION(S):
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Client is being mistreated by another client while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced subsequent complaint visit to the facility. LPA met with Lead Staff Alexis Parker and informed them of the purpose of this visit. During this investigation, the Department conducted interviews with staff and clients; obtained supportive documentation for review to assist with determining the findings for the above noted allegation. The following was determined.

Allegation# 1 - Client is being mistreated by another client while in care. The Department’s investigation consisted of staff, and client interviews. Client and Staff Interviews conducted identified both clients involved as Client One (C1) as allegedly being mistreated by Client Two (C2).

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
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 18-AS-20201118094923
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: 12/04/2023
NARRATIVE
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C1 was interviewed and relayed that C2 had physically assaulted them in the past but denied that it was continuing. Interview with C2 was attempted more than once, but the Department was not successful. Staff and other client interviews were conducted where all stated that C2 had not been seen physically assaulting C1; however, C2 was known to be verbally abusive toward everyone in the facility. Staff interview relayed that C2 told staff when referring to C1, that C2 belonged to C1, and that C2 owns C1.

Staff interview further revealed that C1 indicated to staff that C1 was scared for their life when C2 was around them. Staff mentioned that the facility was working on an alternative plan for C2’s behaviors, but that it had not been completed. Based on staff and client interviews, the regulatory requirement to provide an environment that is free from ridicule was not met. This allegation was Substantiated as a result.

A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted where a copy of this report was discussed with and provided, along with a copy of the LIC811 (confidential names list).

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20201118094923
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: 12/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights: (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning. This was not being met as evidenced by:
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Licensee agrees to provide in-service training on the cited regulation, as well as a plan to address C2's behaviors. This is due by POC date.
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Based on staff and client interviews, C2 was known for their behaviors toward other clients, and a plan to address those behaviors was not completed. Thus, this poses a potential personal rights risk to clients in care.
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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: Rikesha Stamps
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3