374602717-2-15-2022-08-AS-IESA-CC3TZ2-20220228140937

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374602717
Report Date: 02/15/2022
Date Signed: 02/15/2022 03:25:05 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2020 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20201104141753

FACILITY NAME:	M & M RESIDENTIAL		FACILITY NUMBER:	374602717
ADMINISTRATOR:	SMITH, MARVASIA		FACILITY TYPE:	735
ADDRESS:	1504 WHITESTONE ROAD		TELEPHONE:	(619) 825-8487
CITY:	SPRING VALLEY	STATE: CA	ZIP CODE:	91977
CAPACITY:	4	CENSUS: 4	DATE:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Makaila Jenkins, Administrator.		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Lack of supervision resulted in resident sexually assaulting another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to close out a complaint investigation regarding the above-mentioned allegation. LPA identified herself, was granted entry, and stated the purpose of the visit to Makaila Jenkins, Administrator.

During the visit, LPA toured the facility and conducted interviews. It was alleged that Lack of supervision resulted in resident sexually assaulting another resident. Evidence obtained from interviews revealed that on November 3, 2020, an outside source received a telephone call from Client 1 (C1) stating that C1 and C2 had sex. C1 advised the outside source that C2 snuck in their room on two separate occasions and they had sex. C1 reported the incident to a staff member at their day program. C1 told the day program staff member that C2 “raped’ them. C1 was asked by the outside source if C2 forced them to have sex and C1 said” no, it was consensual”.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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 08-AS-20201104141753

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: M & M RESIDENTIAL	FACILITY NUMBER: 374602717
	VISIT DATE: 02/15/2022

NARRATIVE

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C1 then went on to say, they were mad at C2 and that they should have never said C2 raped them. Interviews revealed the sexual encounter was consensual. Interviews revealed, staff members must remain awake at night when residents are sleeping and must do checks on the residents every 15 minutes. Interviews revealed room checks were being completed and there was no evidence to show staff sleep during their night shift.

Based on the evidence obtained from the investigation, the above-mentioned allegation is unsubstantiated.

An exit interview was conducted with Makaila Jenkins. A copy of this report, and Licensee Appeal Rights (9058 01/16) were emailed to Administrator after the conclusion of the visit, LPA Holmes requested an electronic message reply to confirm receipt of these documents.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC9099 (FAS) - (06/04)

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