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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397001473
Report Date: 08/11/2023
Date Signed: 08/16/2023 10:50:22 AM

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
06/26/2023 and conducted by Evaluator Albert Johnson
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20230626193527
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:
08/11/2023
UNANNOUNCEDTIME BEGAN:
09:59 AM
MET WITH:Evelyn (Staff)TIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not ensure that the facility has an adequate supply of perishable foods in the refrigerator for the residents in care.

Staff did not ensure that adequate activities are available to the residents in care.
INVESTIGATION FINDINGS:
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Allegation:Staff did not ensure that the facility has an adequate supply of perishable foods in the refrigerator for the residents in care.

Based on observation and interviews with the staff and the residents the facility had during the department's visits on 1/9/23, 6/28/23 and 8/11/23, the required 2 days perishable food supply. The staff at the facility showed the investigating LPA two refrigerators with food available for use.

The staff also showed the LPA food items labeled as staff this was food separate from the food items used to determine if the facility had the required food items to meet the regulatory requirement for the 2 days perishable mandate. Continued....
Unsubstantiated
Estimated Days of Completion: 0
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
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-20230626193527
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: 08/11/2023
NARRATIVE
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Allegation: Staff did not ensure that adequate activities are available to the residents in care. Based on review of the activities calendar and interviews with the residents the facility appears to have activities scheduled and the residents are participating in these activities and outing. The department was able to confirm some purchases on outing from the personal and incidentals records from 2022 and few from 2023, however some of the entries listed are labeled as cash out and does not list what the cash out was for.

The department finds these allegations to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

As a result of this investigation, no deficiencies cited per Title 22 Regulations, Division 6. LPA conducted exit interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Albert Johnson
LICENSING EVALUATOR SIGNATURE:

DATE: 08/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2