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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397202998
Report Date: 07/26/2024
Date Signed: 07/26/2024 09:29:43 AM

Unsubstantiated


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
06/07/2024 and conducted by Evaluator Avelina Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240607124444
FACILITY NAME:J & R MAGSAYO HOME IIFACILITY NUMBER:
397202998
ADMINISTRATOR:MAGSAYO, RENDENTORFACILITY TYPE:
735
ADDRESS:544 WEST FIFTH STREETTELEPHONE:
(209) 598-6098
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
07/26/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Edwin ValdezTIME COMPLETED:
10:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Neglect/Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/26/2024 at 9:15 AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced to deliver complaint findings. LPA Martinez met with Edwin Valdez during today’s visit and explained the purpose of the visit..

Throughout the investigation, LPA Martinez conducted interviews and reviewed facility records. It was learned Client 1 (C1) has a history of being seeing by medical professionals. Documentation shows C1 received timely medical attention for medical emergencies. Additionally, documentation shows facility staff have been monitoring C1's health and health changes. Facility staff have reported health care change to the appropriate agencies and medical professionals. Moreover, C1 received home health services, which home health staff visited the client regularly. In addition, C1 had a nutritionist that monitored their weight. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, and therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Avelina Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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