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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004519
Report Date: 09/01/2022
Date Signed: 09/01/2022 02:35:24 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2022 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220801104043
FACILITY NAME:PEER HOME #1FACILITY NUMBER:
347004519
ADMINISTRATOR:CUPINO, RAULFACILITY TYPE:
735
ADDRESS:9560 CASTLECAVE WAYTELEPHONE:
(916) 585-9103
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY:4CENSUS: 4DATE:
09/01/2022
UNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Monica ButayTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff are intimidating clients in care
Facility staff are verbally abusive to clients in care
INVESTIGATION FINDINGS:
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On 09-01-2022 at 1:21 PM, Licensing Program Analysts (LPAs) Avelina Martinez and Arielle Pascua conducted an unannounced facility visit in regards to a complaint investigation with the above allegations. LPA Martinez met with Monica Butay and explained the purpose of today's visit.

Throughout the investigation, LPA Martinez conducted interviews and reviewed facility documents. LPA Martinez interviewed three out of four residents. Two out of two residents reported being satisfied with the care they are receiving, and had no issues with any of the staff. Resident 1 (R1) reported one of the residents has behavioral issues and yells at other residents and staff. Resident (R2) reported getting along with staff accept for one. Moreover,R2 reported the staff they were having issues with is not in the facility, and at this time they have no issues. As a result, it was determined there was not enough evidence to prove staff are intimidating clients and verbally abusive.

Continued...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022
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 2
Control Number 27-AS-20220801104043
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: PEER HOME #1
FACILITY NUMBER: 347004519
VISIT DATE: 09/01/2022
NARRATIVE
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Due to the above noted information, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, and therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2