397005502-4-28-2021-27-AS-LKIG-C35LV2-20210518090448

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005502
Report Date: 04/22/2021
Date Signed: 04/28/2021 10:37:43 AM

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
02/19/2021 and conducted by Evaluator Bruce Jacobs

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20210219083428

FACILITY NAME:	MARYANN PATACSIL'S CARE HOME #1		FACILITY NUMBER:	397005502
ADMINISTRATOR:	MARYANN PATACSIL		FACILITY TYPE:	735
ADDRESS:	329 PRADO WAY		TELEPHONE:	(209) 477-5219
CITY:	STOCKTON	STATE: CA	ZIP CODE:	95207
CAPACITY:	6	CENSUS: 6	DATE:	04/22/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Maryann Patacsil, Administrator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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A resident is being restrained
Facility staff are not maintaining fire safety
Staff block bedroom door to prevent a resident from wondering
Staff engaging in verbal altercation

INVESTIGATION FINDINGS:

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LPAs Bruce Jacobs contacted Administrator Maryann Patacsil to complete this complaint investigation. LPA provided findings regarding the allegations listed above. The investigation was conducted by LPA Jacobs and consisted of reviews of the facility records and interviews with facility management and staff. The residents and other witnesses were contacted and interviewed.

The complaint allegations listed above were investigated. The residents, facility staff and management and other witnesses were interviewed by LPA Jacobs. The residents and all staff interviewed denied that the allegations occurred. Other witnesses interviewed provided conflicting information on the allegations. The investigation concluded, based on interviews, inspections and file reviews that the allegations were not proven to be true.

Based on LPA’s observations and interviews conducted, the preponderance of evidence standard has not been met, therefore the above allegations are determined to be UNSUBSTANTIATED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Liza King	TELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Bruce Jacobs	TELEPHONE: (916) 956-5861
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2021

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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