<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602717
Report Date: 11/07/2025
Date Signed: 11/07/2025 11:03:15 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
07/21/2025 and conducted by Evaluator Tiffany Holmes
COMPLAINT CONTROL NUMBER: 08-AS-20250721093119
FACILITY NAME:M & M RESIDENTIALFACILITY NUMBER:
374602717
ADMINISTRATOR:JENKINS, MAKAILA AFACILITY TYPE:
735
ADDRESS:1504 WHITESTONE ROADTELEPHONE:
(619) 825-8487
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY:4CENSUS: 4DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Mia Brown, AdministratorTIME COMPLETED:
10:18 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal items.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA)Tiffany Holmes conducted an unannounced complaint visit to the facility to open complaint on the above-mentioned allegations. LPA identified herself, and met with Mia Brown, Administrator to discuss the purpose of the visit.

LPA was able to conduct a physical inspection of the facility, and collected relevant records, and was able to conduct interviews. It was alleged that the staff did not safeguard resident's personal items. Interviews revealed that Client 1 (C1) stated that they have an EBT card and purchases their own food. Interviews with C1 revealed that they label their food after purchase, and then places the food in the freezer. Interviews revealed that C1 purchased peanut Butter and Jelly crustables with fifteen inside and when they went to retrieve one there were only 9 left in the box. Interviews revealed they also had some chicken strips that were in the freezer that also went missing. Interviews with C1 revealed that they believe another client in the facility is stealing and eating their food. Interviews with staff revealed they offered to replace clients food that was missing because they did not want any issues between the clients. Interviews also revealed that someone did eat C1s food out of the deep freezer that is kept in the garage.

Based on the evidence obtained from interviews, records review, and outside sources, the complaint allegation of staff did not safeguard resident's personal items is substantiated. A deficiency is cited and on the 9099d page.

An exit interview was conducted and a copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) was provided at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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 08-AS-20250721093119
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: M & M RESIDENTIAL
FACILITY NUMBER: 374602717
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/28/2025
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will continue to leave the door locked and monitor the food in the garage. Administrator will provide training to staff on supervision. POC due to CCL by 11/28/2025 and sign in sheet and documents will be sent to LPA by email by 11/28/2025
8
9
10
11
12
13
14
Based on observation & interviews, for 1 of 4 clients (C1), licensee did not safeguard their items (food), which posed a potential personal rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2