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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005336
Report Date: 11/12/2021
Date Signed: 11/12/2021 12:19:12 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/30/2021 and conducted by Evaluator Arlene D Garcia
COMPLAINT CONTROL NUMBER: 27-AS-20210830154657
FACILITY NAME:RM UGALE CARE HOMEFACILITY NUMBER:
397005336
ADMINISTRATOR:MAGSAYO-UGALE, MAYBELYNFACILITY TYPE:
740
ADDRESS:110 E. MT. DIABLO AVENUETELEPHONE:
(209) 836-5215
CITY:TRACYSTATE: CAZIP CODE:
95376
CAPACITY:6CENSUS: 4DATE:
11/12/2021
UNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Mabelyn Magsayo-Ugale, AdministratorrTIME COMPLETED:
12:55 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not allowing resident to call family.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Arlene Garcia made an unannounced visit to RM Ugale to deliver the finding of the above allegation. LPA met with Mabelyn Magsayo-Ugale, Administrator.
It was alleged that the facility is not allowing resident to call family.
LPA toured the facility. LPA observed facility has multiple phones available to the residents. LPA observed a functional phone in both the living and kitchen areas. R1 stated the facility was not allowing R1 to call family. R1 wanted to make arrangements with R1s Responsible Party. R1s responsible parties are R1s immediate family members. R1 is requesting R1s responsible parties make arrangements to move R1 back home. Records reviewed and interviews conducted R1 has been in contact with Responsible Party. Interviews conducted confirm Responsible Party is aware of R1s request and in process of making arrangements. LPA observed that R1 also has full access to email. LPA conducted interviews with 3 residents. All 3 residents stated they had access to the phone.

Based on information provided through interviews and records reviewed, these allegations are deemed UNSUBSTANTIATED, meaning that there was not a preponderance of evidence to prove or disprove that the allegation occurred as reported.

No deficiencies have been cited. Copy of the report provided to AD.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arlene D Garcia
LICENSING EVALUATOR SIGNATURE:

DATE: 11/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021
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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