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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701074
Report Date: 09/14/2022
Date Signed: 09/14/2022 04:56:31 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2022 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20220830094836
FACILITY NAME:MIH-6 CARE HOME INC.FACILITY NUMBER:
392701074
ADMINISTRATOR:ELIZABETH DAVENPORTFACILITY TYPE:
735
ADDRESS:4 WEST ROBINHOOD DR.TELEPHONE:
(209) 244-3898
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:4CENSUS: 3DATE:
09/14/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Kellie KramerTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff member handles resident in a rough manner
Staff failed to treat residents with dignity and respect
Residents were left unattended while in care
INVESTIGATION FINDINGS:
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On 9/14/22 at 1:45pm Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to complete a complaint investigation in to the above listed allegations.

LPA Jensen interviewed 3 of 3 residents, 4 of 8 current staff members, 3 former staff members and a Valley Mountain Regional Center Case Coordinator. In addition, LPA Jensen reviewed the resident file for R1.

With respect to the allegation of staff handling clients in a rough manner, the overwhelming majority of those interviewed denied ever having witnessed or even hearing of clients being handled in a rough manner. The preponderance of evidence standard has not been met therefore the allegationn is UNSUBSTANTIATED.

Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
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 2
Control Number 27-AS-20220830094836
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: MIH-6 CARE HOME INC.
FACILITY NUMBER: 392701074
VISIT DATE: 09/14/2022
NARRATIVE
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With respect to clients being treated without dignity and respect, the overwhelming majority of parties interviewed denied having witnessed or having any knowledge of this occurring. The preponderance of evidence standard has not been met therefore the allegation is UNSUBSTANTIATED.

With respect to clients being left unsupervised, the overwhelming majority of parties interviewed denied having witnessed or having any knowledge of this occurring. All clients in care denied ever having been left unattended. The preponderance of evidence standard has not been met therefore the allegation is UNSUBSTANTIATED.

A finding of unsubstantiated means that while the allegation may have occurred as reported there was insufficient evidence to meet the preponderance of evidence standard.

No deficiencies were observed during the course of this visit and no citations are being issued as a result of this investigation.

An exit interview was conducted and a copy of this report along with appeal rights is was given to Administrator Kellie Kramer.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2