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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397001473
Report Date: 04/25/2024
Date Signed: 04/25/2024 03:31:27 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/07/2024 and conducted by Evaluator Michael Bilger
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240307125623
FACILITY NAME:J & R MAGSAYO HOMEFACILITY NUMBER:
397001473
ADMINISTRATOR:CHERRYL MAGSAYOFACILITY TYPE:
735
ADDRESS:2452 S. FRESNO AVENUETELEPHONE:
(209) 466-4584
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
04/25/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Redentor MagsayoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff made inappropriate comments towards client in care
INVESTIGATION FINDINGS:
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On 4-25-24 at 1:30pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver findings for the allegation noted above. LPA met with Redentor Magsayo and explained the purpose of the visit. This allegation states that facility staff used the words “fat”, “pig” and “pregnant lady” while directed at a resident during a conversation. During this investigation, LPA conducted interviews with three staff members, two residents in care, and an additional witness. Additionally, LPA reviewed facility file documentation including physician reports and individualized program plans (IPPs) for various residents in care. Based on interviews conducted, it was revealed that staff1 (S1) admitted to previously stating to resident3 (R3) that R3 was “getting too fat”, and stated to R2 that R2 was “hardheaded.” Additional interviews conducted resulted in the consistency of these statements. It was further revealed through interviews that resident's expressed feeling offended by these remarks. As a result, the preponderance of evidence standard has been met and this allegation is SUBSTANTIATED.
Deficiencies are cited and noted on LIC 9099D. An exit interview was conducted with Redentor Magsayo and a copy of this report was provided to Redentor. Appeal rights provided. LIC 811 provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
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 2
Control Number 27-AS-20240307125623
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: J & R MAGSAYO HOME
FACILITY NUMBER: 397001473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/06/2024
Section Cited
CCR
80072(a)(3)
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Personal Rights. (a)…each client shall have personal rights which include, but are not limited to, the following: (3) To be free from...humiliation, intimidation, ridicule...or other actions of a punitive nature…This requirement was not met as evidenced by:
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Licensee will ensure completed staff training on resident rights regulation 80072 and submit proof of completed training to LPA by POC due date. Training to include subject on resident dignity.
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Based on interviews, staff member engaged in inappropriate comments towards R3 and R2. This posed a potential health, safety, and resident rights risk to residents in care.
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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: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2