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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604325
Report Date: 07/20/2022
Date Signed: 07/20/2022 12:12:44 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, 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
07/12/2022 and conducted by Evaluator Stephanie Torres
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220712095645
FACILITY NAME:MARAMAFACILITY NUMBER:
374604325
ADMINISTRATOR:SANDISON, HEATHERFACILITY TYPE:
740
ADDRESS:727 ASCOT DRIVETELEPHONE:
(760) 941-9208
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:12CENSUS: 10DATE:
07/20/2022
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Karrie Shotts, Director TIME COMPLETED:
12:20 PM
ALLEGATION(S):
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9
Facility failed to provide telephone communication for residents in care
INVESTIGATION FINDINGS:
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13
Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Karrie Shotts, Director, and informed her of the purpose of her visit.

On this visit the LPA toured the facility, conducted staff/resident interviews, reviewed records and took copies of pertinent documentation.

Pertaining to the allegation, "Facility failed to provide telephone communication for residents in care," it was alleged Residents One (R1) and Two (R2) have not been assisted by facility staff to return messages left for them for approximately two (2) months. R1 was interviewed and denied having knowledge of any messages being left that were not provided to them. R2 was not available to be interviewed at time of visit. Director Shotts was interviewed and denied having knowledge of any messages being left for R1 or R2 which were not forwarded to them. The facility telephone was observed to be available at time of visit. The phone was tested
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
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 4
Control Number 18-AS-20220712095645
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: MARAMA
FACILITY NUMBER: 374604325
VISIT DATE: 07/20/2022
NARRATIVE
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and found to be operable. Shotts reported R1 does have a cell phone that is in the facility's possession, though residents do have access to the phone upon request. Due to a lack of information, this allegation is deemed UNSUBSTANTIATED at this time.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

This report was reviewed with Shotts and a copy was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
07/12/2022 and conducted by Evaluator Stephanie Torres
COMPLAINT CONTROL NUMBER: 18-AS-20220712095645

FACILITY NAME:MARAMAFACILITY NUMBER:
374604325
ADMINISTRATOR:SANDISON, HEATHERFACILITY TYPE:
740
ADDRESS:727 ASCOT DRIVETELEPHONE:
(760) 941-9208
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:12CENSUS: 10DATE:
07/20/2022
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Karrie Shotts, Director TIME COMPLETED:
12:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide appropriate medical care for residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA), Stephanie Torres, conducted an unannounced visit to the facility to initiate the investigation into the above allegation. The LPA met with Karrie Shotts, Director, and informed her of the purpose of her visit.

On this visit the LPA toured the facility, conducted staff/resident interviews, reviewed records and took copies of pertinent documentation.

Regarding this allegation, "Facility failed to provide appropriate medical care for residents," it was alleged Residents One (R1) and Two (R2) have not seen a doctor in two years. Records were reviewed and a Physician's Report for Residential Care Facilities for the Elderly (RCFE) was observed to be available for both R1 and R2. The reports reveal medical assessments were conducted on both R1 and R2 on November 06, 2021. Medical records reveal both R1 and R2 have had subsequent doctor visits. Therefore, based on records,
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20220712095645
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: MARAMA
FACILITY NUMBER: 374604325
VISIT DATE: 07/20/2022
NARRATIVE
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this allegation is deemed UNFOUNDED. A finding that the complaint is unfounded means the allegation is false, could not have happened, and/or is without a reasonable basis.

This report was reviewed with Shotts and a copy was provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 248-0313
LICENSING EVALUATOR NAME: Stephanie TorresTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/20/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4