<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397001473
Report Date: 02/14/2022
Date Signed: 03/01/2022 10:42:29 AM

Substantiated


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
12/23/2021 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20211223161606
FACILITY NAME:J & R MAGSAYO HOMEFACILITY NUMBER:
397001473
ADMINISTRATOR:JUDIE & REDENTOR MAGSAYOFACILITY TYPE:
735
ADDRESS:2452 S. FRESNO AVENUETELEPHONE:
(209) 466-4584
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 6DATE:
02/14/2022
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:R. FernendezTIME COMPLETED:
10:49 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not have an adequate supply of food
Food is not adequately stored
Menu posted in the facility is not being followed
Residents do not have access to snacks
Staff is not following precautions to prevent the spread of illness
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
**This report was amended to add citations which are attached on the 9099D.

Based on records reviewed and interviews conducted the facilty did not have an adequate supply of food. During inspection visits on multiple days and LPA's observation it appears that the food supply is insufficient and does not meet the scheduled menu items. Parties observed a posted menu that was not being followed and sustitutions were not being noted. Also observed were the supply of food in the home that did not meet the 2-day supply of fresh foods requirement. The facility had many containers in the refrigerator and freezer that could not be identified and staff stated they all contained food that belonged to staff. The facility staff showed an additional refrigerator that contained mostly staff food. The facility did not have snacks available for residents (including fresh fruits or foods that could be eaten without being cooked). The pantry with dry goods was locked with a padlock and was removed by staff upon request and remains unlocked.
Substantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
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 3
Control Number 27-AS-20211223161606
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: J & R MAGSAYO HOME
FACILITY NUMBER: 397001473
VISIT DATE: 02/14/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The facility staff also opened the door without a mask and did not conduct a visitor screening for the reporting party. The facility was reminded to conduct the pre-screening procedures for all visitors, regardless of their position when they are coming into the facility.

The facility failed to protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in that facility staff did not document Covid -19 screening questionnaire on multiple occurrences.

Based on LPA's observation, records reviewed and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20211223161606
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: J & R MAGSAYO HOME
FACILITY NUMBER: 397001473
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/15/2022
Section Cited
CCR
80072(a)(2)
1
2
3
4
5
6
7
Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.
This requirement is not met by evidence by:
1
2
3
4
5
6
7
The licensee agrees to submit proof of staff training on visitor screening to LPA by POC due date of
8
9
10
11
12
13
14
Based on observation the licensee did not protect the personal rights of clients in care to receive safe and healthful accommodations and engaged in conduct inimical to the health, welfare, and safety of clients in care, in that Staff did not COVID screen Visitors upon entry which poses an immediate health and safety risk to clients in care.
8
9
10
11
12
13
14
Type B
03/04/2022
Section Cited
CCR
80076(a)(1)
1
2
3
4
5
6
7
 All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. Or 80076(a)(3): Where meal service within a facility is elective, arrangements shall be made to ensure availability of a daily food intake meeting the requirement of (a) (1) above for all clients who, in their admission agreement, elect meal service.
1
2
3
4
5
6
7
Facility will do an in-service on food monitoring and food preparation, and keeping up to date menus. Facility will email LPA in-service training documents and sign in sheet by POC Date
8
9
10
11
12
13
14
This requirement is not met by evidence by:Parties observed a posted menu that was not being followed and sustitutions were not being noted. Also observed were the supply of food in the home that did not meet the 2-day supply of fresh foods requirement.
8
9
10
11
12
13
14
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: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3