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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880735
Report Date: 06/21/2021
Date Signed: 06/21/2021 11:13:16 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/15/2021 and conducted by Evaluator Natalie Gayoso
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20210615090556
FACILITY NAME:DELLA GUEST HOMEFACILITY NUMBER:
361880735
ADMINISTRATOR:GLORYANNE MANGAGEYFACILITY TYPE:
740
ADDRESS:16189 WESTLAND DRIVETELEPHONE:
(442) 229-2016
CITY:VICTORVILLESTATE: CAZIP CODE:
92395
CAPACITY:6CENSUS: 6DATE:
06/21/2021
UNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Anne MangageyTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Staff was verbally abusive toward client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Natalie Gayoso conducted an unannounced visit to the facility to investigate the above allegations. LPA met with Licensee Anne Mangagey and explained the purpose of today's visit. Administrator Nestor Yodong joined shortly after.

The Investigation consisted on interviews with relevant parties. The allegation indicates that staff was verbally abusive towards client. Interviews with Staff #1 (S1) and Staff #3 (S3) stated they have never witnessed Staff #2 (S2) be verbally abusive towards nor yelled at Resident #1 (R1) or any of the other residents in care. S3 stated R1 did have difficulty hearing and staff would have to speak loudly to R1 in order for R1 to understand what was being said. LPA interview S2 who stated they have never been verbally abusive towards R1. R1 was wet and S2 was trying to change R1, but R1 became agressive and sat in the corner during behavior. Interviews with Resident #2 (R2) and Resident #4 (R4) stated they have never witnessed S2 be verbally abusive to R1. Resident #3 (R3) stated staff speak loudly to one of the residents who can not hear, but staff does not yell at residents. R2, R3, and R4 stated S2 and the rest of the staff treat the residents well.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
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 18-AS-20210615090556
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: DELLA GUEST HOME
FACILITY NUMBER: 361880735
VISIT DATE: 06/21/2021
NARRATIVE
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Based on interviews, which were conducted, the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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 were cited during this visit.
An exit interview was conducted, and a copy of this report was provided to the Licensee.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie GayosoTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2