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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 376401726
Report Date: 08/22/2024
Date Signed: 08/22/2024 12:33:23 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
07/15/2024 and conducted by Evaluator Venus Mixson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240715084025
FACILITY NAME:MICHAELLE HOUSEFACILITY NUMBER:
376401726
ADMINISTRATOR:PAUL KEARSCHNERFACILITY TYPE:
736
ADDRESS:687 RIVIERA COURTTELEPHONE:
(760) 758-9165
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:12CENSUS: 11DATE:
08/22/2024
UNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:OPERATIONS MANAGER, CRISTAL KACIREKTIME COMPLETED:
12:58 PM
ALLEGATION(S):
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9
Resident sexually assaulted another resident in care.
INVESTIGATION FINDINGS:
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On August 22, 2024, Licensing Program Analyst (LPA), Venus Mixson conducted a visit to the facility and met with Cristal Kacirek. The purpose of the visit was to provide the complaint allegation findings for the listed allegation.

On July 15, 2024, Community Care Licensing (CCL) received a complaint alleging a resident sexually assaulted another resident in care. It was reported that Resident #2 (R2) exposed his penis to Resident #1 and Resident #2 rubbed his penis on Resident #1’s body. During the investigation, the department conducted interviews with staff, residents, additional Witness and reviewed pertinent documentation.

Regarding the allegation, resident sexually assaulted another resident in care, information obtained from interview with R1 revealed that R1's statements were inconsistent.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024
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 5
Control Number 18-AS-20240715084025
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: MICHAELLE HOUSE
FACILITY NUMBER: 376401726
VISIT DATE: 08/22/2024
NARRATIVE
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 CONTINUATION
During R1's initial disclosure to facility staff, R1 stated that R2 was naked and that R2 touched R1's leg with R2’s hand. The next day, R1 stated that R2 touched R1’s shoulder area with R2’s genitalia. After a subsequent interview, R1 denied the allegation that R2 sexually assaulted R1. Information obtained from interview with R2 corroborated the information. R2 denied that they touched R1 inappropriately. Information obtained from interviews with staff that they were not advised of any issues or concerns pertaining to R1 or R2. Information obtained from interview with Staff Member # 2 indicated they were advised that R2 stood by R1's bed. No further information was obtained.


Based on interviews with staff and residents, record reviews, and observations, the allegations that Resident #2 sexually assaulted Resident #1, may have occurred, however is not supported, or proven by evidence. Therefore, the allegation has been deemed as unsubstantiated at this time.

An exit interview was conducted and a copy of this report, was discussed and given to Operations Manager, Cristal Kacirek.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5