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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 355202855
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:55:47 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/02/2022 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20220902110603
FACILITY NAME:YAI MAGLADRY COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER:
355202855
ADMINISTRATOR:GORENA, HEATHERFACILITY TYPE:
738
ADDRESS:271 MAGLADRY COURTTELEPHONE:
(646) 946-1389
CITY:HOLLISTERSTATE: CAZIP CODE:
95023
CAPACITY:4CENSUS: 3DATE:
11/10/2022
UNANNOUNCEDTIME BEGAN:
09:09 AM
MET WITH:Administrator, Angela GaytanTIME COMPLETED:
11:10 AM
ALLEGATION(S):
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Staff withheld food and water from resident
Staff are misusing resident's money
INVESTIGATION FINDINGS:
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On 11/10/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a subsequent complaint investigation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Angela Gaytan.

During today's inspection, LPA conducted a facility tour, interviewed staff and reviewed records.

Based on interviews, it was determined that facitliy staff limited food and water to C1 while waiting for a medical procedure. Facility tour revealed that the facility as an adequate food supply and residents are provided a small bin with preferred snacks that are accessible throughout the day.

Records review revealed that client purchases are documented and all receipts of purchases are kept. LPA reviewed P&I records and found that the receipts accounted for the purchases made by C1 and C1's remaining balance. CONTINUED TO 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
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 24-AS-20220902110603
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: YAI MAGLADRY COMMUNITY CRISIS HOME (CCH)
FACILITY NUMBER: 355202855
VISIT DATE: 11/10/2022
NARRATIVE
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Based on observation, interviews and records review, the allegations: Staff withheld food and water from resident and Staff are misusing resident's money are UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Administrator, Angela Gaytan, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2