342700896-5-1-2025-59-AS-LMUZ-DGLUKZ-20250512153959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700896
Report Date: 05/01/2025
Date Signed: 05/01/2025 01:23:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2025 and conducted by Evaluator Talwinder Bains

COMPLAINT CONTROL NUMBER: 59-AS-20250319152155

FACILITY NAME:	MVP CAREHOME		FACILITY NUMBER:	342700896
ADMINISTRATOR:	PURUGGANAN, EVELETH R.		FACILITY TYPE:	735
ADDRESS:	5914 WEDGEWOOD AVENUE		TELEPHONE:	(909) 384-2276
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 5	DATE:	05/01/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Caregiver Paz Ynela		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Lack of staff supervision resulting in resident being physically assaulted by another resident.
Staff did not provide the resident with a safe environment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility unannounced on 05/01/25 to deliver complaint findings for above allegations. LPA was greeted by staff, caregiver Paz Ynela to and LPA explained the purpose of today's visit. LPA spoke with Administrator Eveleth Purugganan via phone who gave permission to staff, Paz Ynela to sign this report.

The department conducted records review ,facility observations and interviews to investigate the complaint.

**Report continued on LIC9099-C**

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

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 59-AS-20250319152155

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: MVP CAREHOME	FACILITY NUMBER: 342700896
	VISIT DATE: 05/01/2025

NARRATIVE

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***Report continued from 9099....

Allegation- Lack of staff supervision resulting in resident being physically assaulted by another resident.
Allegation- Staff did not provide the resident with a safe environment.

Based on documents and statements reviewed, the department determined that there was insufficient evidence that the facility lacks supervision resulting in resident being physically assaulted and that staff did not provide residents with a safe environment. Facility records, three (3) staff interviews, and two (2) client interviews, show R1 was a potential risk to other residents, but precautious were taken as ALTA Regional placed R1 on a 1:1 ratio while looking to find a more ideal placement for R1. This remediation plan, alongside weekly and monthly reporting (that all parties are aware of) is providing clients with a safe environment. Based upon the information obtained during investigation, the above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview conducted. Report left with facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025

LIC9099 (FAS) - (06/04)

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