361800118-8-14-2023-56-AS-KCLS-CV6UAG-20230829152444

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800118
Report Date: 08/14/2023
Date Signed: 08/14/2023 12:22:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
08/11/2023 and conducted by Evaluator Magda Malcore

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230811083437

FACILITY NAME:	ANGELIC MANSIONS		FACILITY NUMBER:	361800118
ADMINISTRATOR:	RAJADAS, SHEILA		FACILITY TYPE:	740
ADDRESS:	7585 WARREN VISTA AVE		TELEPHONE:	(760) 365-4620
CITY:	YUCCA VALLEY	STATE: CA	ZIP CODE:	92284
CAPACITY:	15	CENSUS: 11	DATE:	08/14/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Steven Rajadas, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not provide adequate laundry service to resident
Staff did not provide food in the quantity necessary to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a complaint investigation. LPA met with Steven Rajadas, Administrator and discussed the purpose of the visit.

The investigation consisted of LPA observations, interviews, and document review.

Regarding the allegation staff did not provide adequate laundry service to resident, Administrator and staff interviews deny that staff is not providing adequate laundry service to residents in care. Six (6) out of seven (7) residents interviewed stated that the facility does provided adequated laundry service.

Regarding the allegation staff did not provide food in the quantity necessary to meet resident's needs, Administrator and staff interviews deny not providing enough food for residents in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

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 56-AS-20230811083437

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ANGELIC MANSIONS	FACILITY NUMBER: 361800118
	VISIT DATE: 08/14/2023

NARRATIVE

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Administrator stated that the facility provides residents with breakfast, lunch, dinner and snacks.
All seven (7) residents interviewed stated that the facility is providing enough food to meet their needs. LPA toured the kitchen and food storage areas. The facility has a sufficient supply of perishable and non-perishable food items for residents in care.

Based on LPA observations, interviews and document review, the allegations are Unsubtantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to the Administrator at the conclusion of the visit.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Magda Malcore	TELEPHONE: 951-248-0316
LICENSING EVALUATOR SIGNATURE:	DATE: 08/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2023

LIC9099 (FAS) - (06/04)

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