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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336427423
Report Date: 06/11/2021
Date Signed: 06/11/2021 11:28:39 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
08/12/2020 and conducted by Evaluator Deborah Mullen
COMPLAINT CONTROL NUMBER: 18-AS-20200812111453
FACILITY NAME:ALOHA HOME CAREFACILITY NUMBER:
336427423
ADMINISTRATOR:MARTINEZ, IARISH CHRISTIANFACILITY TYPE:
740
ADDRESS:34150 PAMPLONA AVETELEPHONE:
(951) 672-9441
CITY:MURRIETASTATE: CAZIP CODE:
92563
CAPACITY:6CENSUS: 6DATE:
06/11/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Agnes MartinezTIME COMPLETED:
11:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is abusing resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Deborah Mullen conducted an unannounced visit to deliver the findings of the above allegation. LPA met with Agnes Martinez, Administrator. The investigation included a review of R1s facility file and interviews with staff and other witnesses. Due to cognitive abilities resident 1 (R1) was unable to be interviewed.

The allegation states staff is abusing resident. Staff 2 (S2) was interviewed and denied ever hitting or punching resident. S2 stated R1 can get agitated and become combative when staff are changing him/her, but again denied ever hitting R1. Staff 1 & 3 (S1 & S3) were interviewed and denied ever hitting or witnessing anyone else hitting R1. Additional witness interviews could not corroborate R1 being hit by S2. LPA attempted to interview R1, however due to speech and cognitive impairments, LPA was unable to conduct a viable interview.

Therefore, based on the investigation the allegation that staff are abusing resident is unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated at this time. An exit interview was conducted and a copy of this report was reviewed with and provided to Ms. Martinez.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Deborah Mullen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021
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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