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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880895
Report Date: 10/16/2023
Date Signed: 10/16/2023 09:54:58 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 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
08/10/2023 and conducted by Evaluator Kathleen Banrasavong
COMPLAINT CONTROL NUMBER: 18-AS-20230810164347
FACILITY NAME:ATTENTIVE MANOR IIFACILITY NUMBER:
331880895
ADMINISTRATOR:PECK, CHRISTOPHERFACILITY TYPE:
740
ADDRESS:31221 EL TORO RDTELEPHONE:
(760) 620-5915
CITY:CATHEDRAL CITYSTATE: CAZIP CODE:
92234
CAPACITY:6CENSUS: DATE:
10/16/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator, Christopher PeckTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff was in a verbal altercation in presence of a resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kathleen Banrasavong made an unannounced visit to the facility to commence a complaint investigation regarding the allegation listed above. LPA met with Licensee, Matt Siegel where LPA explained the purpose of the visit and the elements of the allegation. The allegation was investigated, the investigation consisted of observation, interviews with staff members and residents, and record review. LPA was unable to obtain contact with additional witnesses.

On 08/10/2023, Community Care Licensing received a complaint stating that staff was in a verbal altercation in presence of a resident. It was reported that staff members were arguing and having an inappropriate interaction in front of Resident #1. In regards to the allegation that staff was in a verbal altercation in the presence of a resident, information obtained from interviews stated that there was no verbal altercation incident that occurred in front of residents. Interviews with residents indicated that there were no issues or concerns regarding staff behaving appropriately. Interviews with residents corroborated the information obtained from staff.

(Continued on 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
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 18-AS-20230810164347
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATTENTIVE MANOR II
FACILITY NUMBER: 331880895
VISIT DATE: 10/16/2023
NARRATIVE
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Continuation from 9099)

Based on LPA’s observation, interview conducted and record review(s), the preponderance of evidence shows that the allegations is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, a copy of this report, appeal rights was provided to the Licensee, Matt Siegel, as evidenced by his signature.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Kathleen Banrasavong
LICENSING EVALUATOR SIGNATURE:

DATE: 10/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2