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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005503
Report Date: 09/14/2021
Date Signed: 09/14/2021 05:36:07 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
06/07/2021 and conducted by Evaluator Ashley Boothe
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20210607152154
FACILITY NAME:MARYANN PATACSIL'S CARE HOME #2FACILITY NUMBER:
397005503
ADMINISTRATOR:MARYANN PATACSILFACILITY TYPE:
735
ADDRESS:335 PRADO WAYTELEPHONE:
(209) 477-4915
CITY:STOCKTONSTATE: CAZIP CODE:
95207
CAPACITY:6CENSUS: 6DATE:
09/14/2021
UNANNOUNCEDTIME BEGAN:
02:58 PM
MET WITH:Maryann PatacsilTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff inappropriately touched a client while in care
INVESTIGATION FINDINGS:
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On 09/14/2021 at 2:58pm, Licensing Program Analyst (LPA) Ashley Boothe spoke with Licensee regarding facility risk assessment questions who confirmed no staff or clients have experienced symptoms within the last 10 days. At 3:05pm, LPA Ashley Boothe arrived unannounced to conclude a complaint investigation with the following allegation: Staff inappropriately touched a client while in care. LPA explained the purpose of today’s visit. LPA was allowed entry into the facility and met with Designated staff (S1) and Licensee arrived shortly after. Census 6.

During the course of the investigation the department reviewed records, conducted on site inspection and interviews. It was determined through the investigation that Resident one (R1) gave inconsistent statements about when or how long Staff two (S2) was touching R1. Licensee and Staff three (S3) interviewed R1 as reported in Valley Mountain Regional Center Incident report during which R1 changed aspects of origional allegation. Resident two (R2) was in the room during the alleged incident but was not able to provide a verbal statement due to diagnosis. R1 has a history of lying but not false allegations. S2 stated there was no inappropriate touching only S2 taking R1's vitals for COVID-19.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Ashley Boothe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
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-20210607152154
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: MARYANN PATACSIL'S CARE HOME #2
FACILITY NUMBER: 397005503
VISIT DATE: 09/14/2021
NARRATIVE
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It was determined in the course of the investigation based on the information provided through documentation and interview, the aforementioned allegation is unsubstantiated. A finding that the allegation 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.

LPA encountered computer consistency check and stepped away at 4:30pm and returned at 5:00pm to finalize reports and print documents.

Per the California Code of Regulations, Title 22, Division 6, no deficiencies observed or cited. Exit interview held, copy of report given.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Ashley Boothe
LICENSING EVALUATOR SIGNATURE:

DATE: 09/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/14/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2