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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002912
Report Date: 11/06/2025
Date Signed: 11/06/2025 11:10:26 AM

Substantiated


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
05/23/2025 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20250523100844
FACILITY NAME:MC HOME CARE, INC.FACILITY NUMBER:
345002912
ADMINISTRATOR:MONTE, JACELYNFACILITY TYPE:
735
ADDRESS:7628 BLACKTHORNE WAYTELEPHONE:
(916) 560-9201
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:4CENSUS: 4DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jacelyn Monte TIME COMPLETED:
11:15 AM
ALLEGATION(S):
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Facility staff are not awake clients require assistance
Facility staff are providing expired food to clients
INVESTIGATION FINDINGS:
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On 11/06/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licesning Program Manager (LPM) Laura Munoz arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 05/23/2025. LPA met with Administrator, Jacelyn Monte and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.


Please contiune to LIC9009C....
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Cheyenne Ratajczak
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 59-AS-20250523100844
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: MC HOME CARE, INC.
FACILITY NUMBER: 345002912
VISIT DATE: 11/06/2025
NARRATIVE
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Allegation: Facility staff are providing expired food to clients- Substantiated

On 05/28/2025 LPA observed the following:


9:21 a.m. LPA observed expired milk- Lactaid 2% reduced fat milk- May 21, 2025
9:27 a.m. LPA observed expired Almond Breeze Chocolate almond milk- May 4, 2025
9:27 a.m. LPA observed expired Almond Breeze unsweetened original May 19, 2025
Administrator immediately throw out all the items.
LPA conducted another visit on 09/11/2025 and did not observe the facility to have expired food.

Based on the information obtained for the allegation, facility staff served expired food to residents, the allegation is SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Allegations: Facility staff are not awake clients require assistance- Substantiated

On 05/28/2025 facility had one staff member working. Staff were awake and assisted LPA and residents during time of the visit. On 09/11/2025 LPA arrived at the facility and was greeted by two staff members. They were assisting residents and helping LPA until Administrator arrived. During the course of the investigation, a photo was obtained where a staff was sleeping on the couch when residents were awake and present in the facility. The Administrator was shown the photograph and confirmed staff was sleeping while on duty.

Based on the information obtained for the allegation, facility staff are not awake, the allegation is SUBSTANTIATED- A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.



Exit interview conducted and a copy of the report and appeal rights was left at the facility.
NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Cheyenne Ratajczak
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
05/23/2025 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20250523100844

FACILITY NAME:MC HOME CARE, INC.FACILITY NUMBER:
345002912
ADMINISTRATOR:MONTE, JACELYNFACILITY TYPE:
735
ADDRESS:7628 BLACKTHORNE WAYTELEPHONE:
(916) 560-9201
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95621
CAPACITY:4CENSUS: DATE:
11/06/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Jacelyn Monte TIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
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5
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7
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9
Facility staff did not ensure that dangerous items were inaccessible to the clients
Facility staff are not properly safeguarding medications
Facility staff do not keep facility odorless
Facility staff are not keeping facility clean and orderly
INVESTIGATION FINDINGS:
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On 11/06/2025, Licensing Program Analyst (LPA) Cheyenne Ratajczak and Licesning Program Manager (LPM) Laura Munoz arrived at the facility unannounced to deliver final findings to a complaint Community Care Licensing (CCL) received on 05/23/2025. LPA met with Administrator, Jacelyn Monte and explained the purpose of the visit.

During the course of the investigation, the Department conducted interviews and record review.


Please contiune to LIC9009C....
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Cheyenne Ratajczak
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
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 59-AS-20250523100844
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: MC HOME CARE, INC.
FACILITY NUMBER: 345002912
VISIT DATE: 11/06/2025
NARRATIVE
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Allegation: Facility staff are not properly safeguarding medications

During LPA visit on 05/28/2025 LPA observed an albuterol in its box on an end table near the couch. Administrator stated the medications was theirs and they were using it when LPA arrived at the facility. The Administrator was advised that all medications in the facility need to be inaccessible to residents. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Allegation: Facility staff did not ensure that dangerous items were inaccessible to the clients- Unsubstantiated

LPA conducted a tour on 05/28/2025 and 09/11/2025. During both visits LPA observed all dangerous items to be locked and inaccessible to residents in care. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Allegation: Facility staff do not keep facility odorless- Unsubstantiated

LPA conducted a tour of the facility on 05/28/2025 and 09/11/2025 and did not observe the facility to have an odor. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Allegation: Facility staff are not keeping facility clean and orderly- Unsubstantiated

LPA conducted a tour of the facility on 05/28/2025 and 09/11/2025 and observed the facility to be clean and orderly. Based on this information, these allegations are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are unsubstantiated.

Exit interview conducted and a copy of the report and appeal rights was left at the facility.

NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Cheyenne Ratajczak
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 59-AS-20250523100844
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: MC HOME CARE, INC.
FACILITY NUMBER: 345002912
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/20/2025
Section Cited
CCR
80076(a)(1)
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(a)In facilities providing meals to clients, the following shall apply:
(1)All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner.
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Licensee will conduct an audit of all food products to ensure that there are no expired food products available to clients in care. Additionally, Licensee will come up with a written procedure to ensure staff are checking expiration dates and throwing out items that are passed expiration.
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This requirement is not met as evidenced by:
Based on observation, the licensee did not ensure that all food available to clients in care was not expired which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
11/20/2025
Section Cited
CCR
80076(a)
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80078 Responsibility for Providing Care and Supervision (a)The licensee shall provide care and supervision as necessary to meet the client's needs.
This requirement is not met as evidenced by:
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Licensee developed a task checklist that staff are responsible for completing during thier shifts, Additionally, the Administrator does periodic drop ins and calls the facility landland at varies times throughout the day. The Administrator will continue to follow up with staff to ensure staff are awake during duty
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Based on record review and interview it was revealed that a staff fell asleep on the couch while working the day shift with residents in care.
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and completing tasks as assigned. Administrator shall submit a statement of understanding regarding this regulation. POC shall be completed by 11/20/2025.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: Laura Munoz
NAME OF LICENSING PROGRAM ANALYST: Cheyenne Ratajczak
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 11/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5