331800464-7-13-2023-18-AS-JESL-CU8TMG-20230730145108

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331800464
Report Date: 07/13/2023
Date Signed: 07/13/2023 09:26:21 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/10/2023 and conducted by Evaluator Javina George

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20230510142259

FACILITY NAME:	MASHBURN HOMES INC		FACILITY NUMBER:	331800464
ADMINISTRATOR:	MARIAN BUNDALIAN		FACILITY TYPE:	740
ADDRESS:	853 PIKE DR		TELEPHONE:	(951) 927-0611
CITY:	HEMET	STATE: CA	ZIP CODE:	92544
CAPACITY:	5	CENSUS: 4	DATE:	07/13/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Christopher Bunalian, Administrator		TIME COMPLETED:	09:35 AM

ALLEGATION(S):

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Staff member slapped resident
Facility staff refused to change client's soiled diaper.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with Christopher Bunalian, Administrator and explained the purpose of the visit and the elements of the allegation(s). The allegations were investigated, the investigation consisted of observation, interviews and record review.

Regarding the allegation of staff member slapped resident. It was reported that on or around 5/10/2023, that Resident #1 (R1) was slapped in their face by Staff #1 (S1) while S1 was assisting them with their shower. Interviews conducted with R1 revealed that yes, they did report that they were slapped by S1, but later in the day stated that they lied about it happening. Per the inteview conducted with S1, S1 denied that they ever slapped R1 or any of the other residents in the home. Further Interviews with members of R1's treatment team revealed that R1 does have history of making false statements, and then recanting the statements. However this time around R1 was adamant about this alleged incident happening and wanting it to be reported to the home. This request of R1's is not reported to have this type of response as usual as in

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

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 18-AS-20230510142259

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: MASHBURN HOMES INC	FACILITY NUMBER: 331800464
	VISIT DATE: 07/13/2023

NARRATIVE

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the past R1 would normally say please do not say anything if there is a scratch observed. Due to the inconsistencies and R1 recanting their statement stating that they lied about what happened, after having exhibited behavior out of their baseline, the allegation of Staff member slapped resident is UNSUBSTANTIATED.

Regarding the allegation facility staff refused to change client's soiled diaper.

Per the interview conducted with R1, R1 did not confirm nor deny the allegation of staff refusing to change their diaper. Interviews conducted with facility staff revealed that they denied ever having to refuse to change any of the residents. There was a time when R1 did not attend the day program because there were constant complaints of them arriving to the program soiled, but they were always changed and must have used the restroom in route to the program. A review of documentation revealed that R1 did have an increased bowel movements and may be contributed to the coffee that they were drinking or the medication that they were prescribed. However, the facility staff interviews also revealed that residents with incontinent needs are checked every two hours, and in addition are assisted when the resident has made the request known to be changed. Due to insufficient evidence, the allegation of facility staff refused to change client's soiled diaper is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means that 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.

An exit interview was conducted and a copy of this report was provided to Christopher Bunalian, Administrator.

SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Javina George
LICENSING EVALUATOR SIGNATURE:	DATE: 07/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023

LIC9099 (FAS) - (06/04)

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