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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366423857
Report Date: 09/25/2023
Date Signed: 09/25/2023 11:20:39 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/21/2023 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230921160607

FACILITY NAME:MCKINLEY CARE HOMEFACILITY NUMBER:
366423857
ADMINISTRATOR:APRILLELYN PANALIGANFACILITY TYPE:
735
ADDRESS:9895 MCKINLEY ST.TELEPHONE:
(909) 944-9360
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:4CENSUS: 3DATE:
09/25/2023
UNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Administrator Aprillelyn PanaliganTIME COMPLETED:
11:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff over medicated resident while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to initiate a complaint investigation regarding the above . LPA Prieto met with Administrator Aprillelyn Panaligan, interviewed staff and gathered pertinent documentation.

Regarding the allegation that staff over medicated resident while in care, the medication administrative record (MAR) log was obtained and resident #1 (R1) in question has been given their medication as prescribed with no evidence that R1 is over-medicated.

Based on the information obtained there is not enough evidence that staff over medicated resident while in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

This report was signed by LPA Prieto and administrator Panaligan and a copy was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023
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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