134603515-8-24-2023-08-AS-DPOL-CV7TTK-20230830150051

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 134603515
Report Date: 08/24/2023
Date Signed: 08/24/2023 11:21:46 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/08/2023 and conducted by Evaluator Renita Hall

COMPLAINT CONTROL NUMBER: 08-AS-20230308105615

FACILITY NAME:	MAZEROLL RESIDENTIAL SERVICES		FACILITY NUMBER:	134603515
ADMINISTRATOR:	GARRETT MAZEROLL		FACILITY TYPE:	735
ADDRESS:	286 W. CANCUN DR.		TELEPHONE:	(760) 545-0362
CITY:	IMPERIAL	STATE: CA	ZIP CODE:	92251
CAPACITY:	6	CENSUS: 6	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Krista Flores, Manager		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Client was inappropriately touched at facility (Personal Rights)

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Renita Hall conducted an unannounced complaint visit to deliver findings regarding the above-mentioned allegation. LPA identified herself and was allowed into the facility by Kylah Aguilera and Krista Flores.

The Department investigated the above complaint allegation. The investigation consisted of a tour of the facility, interview with staff, residents, and records review.

On March 8, 2023, a complaint was received alleging Client 1 (C1) was inappropriately touched at facility. Records reviewed indicated that C1 primary Diagnosis: Schizoaffective Disorder, Impulse Control, Disruptive Behavior. The Individual Program Plan (IPP) noted that C1 engaged in behaviors such as physical aggression which included hitting, kicking, scratching, forcefully grabbing others, pulled hair and biting.

Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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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Control Number 08-AS-20230308105615

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: MAZEROLL RESIDENTIAL SERVICES	FACILITY NUMBER: 134603515
	VISIT DATE: 08/24/2023

NARRATIVE

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C1 has emotional outburst that included screaming, yelling, directing profanity towards others, slamming doors, throwing/breaking items, and mild self-injuries. C1's plan has noted that: Outcome #3: "C1 will tell the truth in all situations rather than make false allegations to no more than 1x per month for attention through February 29, 2024."

Interviews conducted with staff and other residents concluded that no one had witnessed or heard of anyone that was inappropriately touched at the facility.

There was insufficient evidence found to support the allegations that client was inappropriately touched at facility. Due to a lack of evidence, the allegations are deemed to be Unsubstantiated. A finding that is unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted with the Krista Flores, Manager. A copy of this report and Licensee's Rights (LIC 9058 03/22) were provided to the Krista Flores, Manager and her signature on this report confirms receipt of the Licensee Rights.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Renita Hall
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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