<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604273
Report Date: 07/31/2025
Date Signed: 07/31/2025 10:46:17 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2021 and conducted by Evaluator Donna Teutschel
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20210623111437
FACILITY NAME:CASA MAHALFACILITY NUMBER:
374604273
ADMINISTRATOR:FRAZIER, THERESAFACILITY TYPE:
740
ADDRESS:12631 CASA AVENIDATELEPHONE:
(858) 924-1136
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: DATE:
07/31/2025
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Theresa FrazierTIME COMPLETED:
10:40 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained a stage 2 pressure injury while in care.
Resident's responsible party was not notified of change in condition.
Staff do not meet resident's hygiene needs.
Licensee did not follow physician's orders.
Facility has insufficient staffing.
Licensee does not provide adequate food service.
Licensee does not offer any activities.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
LPMII RA, Donna Teutschel, conducted a telephone interview with Theresa Frazier regarding the above allegations. Refer to complaint #08-AS-2021072110943 regarding same resident for additional interviews interviews and LPA observations. Allegation - Resident sustained a stage 2 pressure injury while in care. While it is established that R1 establised a stage 2 pressure injury on his coccyx as verified by R1's physician report dated 7/16/21, it was not determined that the pressure injury was caused by any staff neglect. Pressure injury was being treated by Unicare Home Health.

Allegations - Resident's responsible party was not notified of change in condition;Staff do not meet resident's hygiene needs; Licensee did not follow physician's orders;Facility has insufficient staffing;
Licensee does not provide adequate food service; Licensee does not offer any activities. Based upon interviews obtained there is insufficient evidence in support these allegations occurred. While R1 may have lost weight, he was offered choices of foods and was in a declining state which R1's responsible party was aware. It was not established that R1's declining condition had to do with inadequate food service,.insufficient staffing, not following physician's orders or not meeting hygiene needs. There was evidence acivities offered but no information from RP on this allegation.

All allegations are determined to be Unsubstantiated.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stacy Barlow
LICENSING EVALUATOR NAME: Donna Teutschel
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2025
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 1