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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336402994
Report Date: 09/09/2024
Date Signed: 09/09/2024 03:10:48 PM

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
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240904160642
FACILITY NAME:LIFESTYLE HOME CAREFACILITY NUMBER:
336402994
ADMINISTRATOR:MARY MATEASFACILITY TYPE:
740
ADDRESS:5377 CAROL WAYTELEPHONE:
(951) 684-5833
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 3DATE:
09/09/2024
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Mary Mateas, AdministratorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Staff hit resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to initiate a complaint investigation regarding the above allegation LPA Prieto met with Administrator Mary Mateas and explained the elements of the complaint.

Regarding the allegation that staff hit resident in care, LPA Prieto interviewed resident #1 (R1), in question, and expressed that staff does not hit or mistreat R1 while in care. LPA interviewed R2, who states that staff does not hit R2 or witnessed staff hit any other resident in care. LPA interviewed R3, who states that staff does not hit R2 or witnessed staff hit any other resident in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
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 56-AS-20240904160642
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
, CA 92507
FACILITY NAME: LIFESTYLE HOME CARE
FACILITY NUMBER: 336402994
VISIT DATE: 09/09/2024
NARRATIVE
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LPA Prieto interviewed staff #1 (S1), who states that S1 has not hit any resident in care or witnessed any other staff hit resident while in care. LPA Prieto interviewed staff #2 (S2), who states that S2 has not hit any resident in care or witnessed any other staff hit resident while in care.

Based on the information obtained there is not enough evidence that staff hit resident in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Administrator Mary Mateas and a copy was left at the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2