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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604385
Report Date: 07/24/2024
Date Signed: 07/24/2024 11:01:55 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
07/18/2024 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240718122239
FACILITY NAME:MAJELLA ASSISTED LIVING OF SAN MARCOSFACILITY NUMBER:
374604385
ADMINISTRATOR:MORRISON, JIMFACILITY TYPE:
740
ADDRESS:558 SMILAX RD.TELEPHONE:
(760) 734-5786
CITY:SAN MARCOSSTATE: CAZIP CODE:
92078
CAPACITY:11CENSUS: 11DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Jim MorrisonTIME COMPLETED:
10:02 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not treat resident with respect
Staff spoke inappropriately to resident
Staff touched resident inappropriately
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Jim Morrison who was informed of the purpose of the visit. During the visit, LPA conducted interviews, conducted a walk through, and conducted records reviews.

The allegations made above pertained to Resident #1 (R1) not being treated with respect by staff, spoken to inappropriately by staff, and touched inappropriately by staff. LPA conducted a walk through of the facility on today's date and obtained all the resident's names. LPA reviewed the resident records and found R1 does not reside at the home. LPA conducted interviews with staff who reported R1 does not reside in the home. LPA confirmed with staff the move out and deaths for the last (3) months. Therefore, this agency has investigated the complaint allegations and have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted, and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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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