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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397202998
Report Date: 01/29/2025
Date Signed: 01/29/2025 09:41:02 PM

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
11/01/2024 and conducted by Evaluator Jason Lund
COMPLAINT CONTROL NUMBER: 27-AS-20241101162814
FACILITY NAME:J & R MAGSAYO HOME IIFACILITY NUMBER:
397202998
ADMINISTRATOR:MAGSAYO, RENDENTORFACILITY TYPE:
735
ADDRESS:544 WEST FIFTH STREETTELEPHONE:
(209) 937-9793
CITY:STOCKTONSTATE: CAZIP CODE:
95206
CAPACITY:6CENSUS: 5DATE:
01/29/2025
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Care Staff Edwin Valdez TIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff hit a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jason Lund arrived unannounced to complete a complaint investigation regarding the above allegation. LPA Lund met with Care Staff Edwin Valdez and telephoned Administrator Rendentor Magsayo who could not make to the facility. LPA Lund explained the reason for the visit Administrator Rendentor Magsayo and he gave permission for Care Staff Edwin Valdez to sign required paperwork. Census: 5
Staff hit a resident in care - LPA Lund reviewed facility records, interviewed staff, witnesses and clients in care. LPA Lund reviewed staff training on Required Reporting of Dependent Adult Abuse. Staff interviewed stated that have the proper training and never witnessed any staff hit a resident. They would have notified management immediately. Witnesses stated that they have never seen any signs of physical abuse from the clients from the facility. Clients interviewed stated they have never been abused (Hit) by staff from the facility or anyone.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
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-20241101162814
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 II
FACILITY NUMBER: 397202998
VISIT DATE: 01/29/2025
NARRATIVE
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Based on, reviewed facility records, interviewed staff, witnesses and clients in care the information provided, it was unclear if staff hit a resident in care, therefore the allegation was deemed UNSUBSTANTIATED.

As a result of this investigation, this Department finds the allegation to be UNSUBSTANTIATED. A complaint allegation finding of 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. Exit interview conducted and report left.

SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Jason Lund
LICENSING EVALUATOR SIGNATURE:

DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2