raw_content:
Narrative:
Documentary evidence and additional information gathered in confidential interviews with C1 and staff reveal C1 participation in activities such as playing with puzzles and board games with staff. LPA obtained a copy of the monthly activity log. Confidential interviews and consistent statements made by staff and C1 also reveal staff has not restrained C1 resulting in injury to C1. LPA conducted a file review for Staff #1 (S1), Staff #2 (S2), and Staff #3 (S3). Documentary evidence revealed staff are ProAct trained and certified. LPA obtained ProAct certificates for S1, S2, and S3. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On February 27, 2023 at 10:19am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Tianna Gammage, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. Facility Manager informed LPA that Administrator is out on Administrative Leave on this day. LPA spoke with Administrator by telephone at (562) 540-7724 and discussed the findings. During the investigation, a total of four (4) staff and one (1) client were interviewed. Confidential interviews with staff and Client #1 (C1) did not reveal C1 spends an excessive time in their room and facility staff do not provide C1 with activities. Consistent statements from staff and C1 reveal, C1 has been on outings to the park and to the beach as well as other outings in the residential area of the facility. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 02/27/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Tianna Gammage-Facility Manager


state: CA

facility_name: PEOPLE'S CARE GARTH

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Although, confidential witness statements revealed "Staff caused injuries to a minor while in care", staff denied the allegation and the alleged victim denied the allegation. There is no evidence or witnesses to support that "Staff caused injuries to a minor while in care". LPA was unable to obtain the identity of the alleged perpetrator. Statements made by Client #1 (C1) revealed that the incident did not happen, and no injuries were caused by staff to C1. Inconsistent statements made by staff and C1 regarding incident in which C1 alleged falling off the facility trampoline could not be corroborated. Documentary evidence revealed, C1 initially reported to staff that they fell off the facility trampoline but later recanted the statement stating that the trampoline broke. LPA obtained a copy of General Events log for C1. LPA conducted an inspection of the facility trampoline on 2/27/2023. LPA observed the trampoline to be damaged and in disrepair due to inclement weather conditions of winds and rain during the week of 2/20/2023-2/25/2023. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13This an amended report from the original date of 12/8/2022. On February 27, 2023 at 10:57am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Tianna Gammage, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegation. Facility Manager informed LPA that Administrator is out on Administrative Leave on this day. LPA spoke with Administrator by telephone at (562) 540-7724 and discussed the findings. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. LPA made several unsuccessful attempts to conduct confidential interviews with Staff #2 (S2). Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 02/27/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

report_type: Complaint Investigation

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential statements and record review produced inconsistencies. Statements obtained indicate no disclosures of C1 being touched inappropriately but rather concerns of staff entering and monitoring client while in use. Record review indicates C1 was first place in November 2022. C1 was scheduled to begin school on March 14, 2023. Administrator indicates the delay in C1 starting school was due in part, to not obtaining required paperwork timely and C1's unforeseen admissions to the hospital. Based on gathered information the allegations cannot be substantiated due to a lack of corroborating evidence. The findings concerning personal rights and neglect are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Representative.

Investigation Findings:
13On May 5, 2023, at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at the Hargis Adult Residential Home to deliver findings concerning allegations against PEOPLE'S CARE GARTH. LPA Martin met with Facility Representative Dajahnae Warmack, DSP II, to discuss the outcome. LPA Martin also spoke with Facility Administrator, Vera Adidi via telephone. The investigation was referred and conducted by LPA Martin and Community Care Licensing Investigations Bureau. On March 2, 2023, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging personal rights and neglect towards Client #1 (C1) who was reportedly touched inappropriately by a staff member, and that the Facility did not ensure C1 attended school [see Confidential Names form, LIC 811, dated 5/5/2023]. On March 7, 2023, LPA Martin met with Facility Administrator, reviewed client file, and obtained pertinent related information. The investigation further consists of review of facility file, review of associated reports from the Department of Children and Family Services and confidential interviews with related parties including, but not limited to, C1, complainant, and assigned Social Worker. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 05/05/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Dajahnae Warmack, DSPII


summary: Facility Evaluation

raw_content:
Narrative:
On October 21, Licensing Program Analyst (LPA), Daphne Edison and Licensing Program Manager (LPM) Lakescia Smith, made an unannounced visit to People's Care Garth to conduct an annual required visit inspection at the above location. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory only. Only two (2) children may be non-ambulatory. Currently there are two (2) children in placement. There is no swimming pool or bodies of water on the premises. LPA, Edison met with direct support staff Tianna and Dajahnae. LPA spoke with the administrator, Crystal Garcia by phone and informed her of the inspection. The home is a single family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, a living room, dinning area, kitchen, laundry area, a detached garage and backyard. Bedroom #1 and #2 has one female resident each with full size bed, adequate drawer and closet space. Bedroom #3 and #4 is vacant with full size bed, adequate drawer and closet space. Continue on next page Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA observed non-perishable foods for one week and perishable food for two days. The living room and dining room area has adequate seating capacity. All trash cans have tight fitted lids. All beds are in good repair. The medications are locked above the washer and dryer cabinets and accessible only to employees supervising stored medications. The home has a first aid kit stored above the washer and dryer, the fire extinguisher is located to the side of the washer and dryer fully charged. Disinfectants and poisons are inaccessible to the children in care they are kept locked below the kitchen sink. All knives and sharp objects are made inaccessible to the children in care locked in a cabinet and storage room who only staff members have access to. The hot water temperature is within a acceptable temperature range. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. The yard is free of debris and hazardous material. LPA observed a basketball court and trampoline. The garage is currently being used as an office space with desks, computers, and cabinets. In the garage there are also boxes that have extra cleaning supplies such as gloves and wipes. LPA will follow up with the facility Administrator, Crystal for the two (2) direct support staff who do not appear to be cleared under the DOJ/FBI and Child Abuse Index personnel roster. Exit interview was conducted and a copy of this report will be emailed to the facility. Note: An exception was received on 10/20/2021 to accept a 14 year old in the program. LPM informed Crystal that an exception is not required and to follow their plan of operation and license which states they have been approved to accept ages 12-17 years old. Although the program have regional center clients 19 years old, the client's can remain in placement until age 22.

report_type: Facility Evaluation

visit_type: Annual

met_with: Dajahnae Warmack


summary: Facility Evaluation

raw_content:
Narrative:
On November 17, 2021 at 9:45am, Licensing Program Analysts (LPA's), Daphne Edison and Enriquez Hernandez, and Licensing Program Manager (LPM) Lakescia Smith made an unannounced visit to People's Care Garth to conduct a case management annual continuation inspection which took place on October 21, 2021 at the above location. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory only. Only two (2) children may be non-ambulatory. Currently there are two (2) children in placement. During the time of the inspection, LPA's and LPM observed a shattered television glass in the living room mounted on the wall. Administrator informed LPA's that the facility has a new TV and is waiting for the protective plexiglass to install it. LPA Hernandez informed the administrator that the TV needs to be removed for the safety of the clients in care. LPA's conducted operations and disaster preparedness Sections. Due to time constraints, LPA's shall return to review personnel and client files to ensure it meets regulatory requirements. Staff interviews will be conducted at a later date. PER California Code Regulation, TITLE 22, DIVISION 5, CHAPTER 1, General Licensing Regulations, a deficiency was cited at this time. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

visit_type: Case Management

met_with: Crystal Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On December 13, 2021 at 10:11am, Licensing Program Analyst (LPA's), Daphne Edison made an unannounced visit to People's Care Garth to conduct a case management annual continuation inspection which took place on October 21, 2021 and November 17, 2021 respectively, at the above location. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory only. Only two (2) children may be non-ambulatory. Currently there is one (1) child in placement. The census on the date of the visit is one (1). LPA, Edison met with Tianna Gammage, House Lead, who granted access to the facility. The home is a single -family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, a living room, dining area, kitchen, laundry area, a detached garage and backyard. During this visit, LPA reviewed one (1) client record which contained copies of the Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported by the House Lead that child(ren) attend school, extracurricular, cultural and personal enrichment activities. Continued on LIC 809-C During this visit LPA also conducted two (2) confidential staff interviews and reviewed five (5) staff records stored in individual personnel files. LPA ensured to thoroughly review the records of the primary active staff (i.e The Program Administrator, House Lead; and three (3) Direct Care Staff. and found facility personnel meet staff qualifications. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. The home is operating within the capacity and limitations of the license. On October 21, 2021, facility was issued a technical violation for HSC 1565(e)(1), (e) A facility shall have all of the following information readily available during an emergency: (1) A roster of individuals served by the facility, with the date of birth for each individual. On October 21, 2021, facility was issued a technical violation for CCR 84009(a), (a) The license shall be posted in a prominent, publicly accessible location in the facility. On November 17, 2021, facility was issued a technical violation for CCr 84063(a)(10), (a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties: (10) Ensure that all minutes of board of directors' meetings are available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. Minutes may be removed if necessary for copying. Removal of minutes shall be subject to the following requirements: On November 17, 2021, facility was issued a technical violation for HSC 1565(a)(6), (a), A facility shall have an emergency and disaster plan that shall include, but not be limited to, all of the following: (6) The location of utility shutoff valves and instructions for use. LPA was provided with documents from the administrator to clear the above technical violations on December 13, 2021. Continued on LIC 809-C On November 17, 2021, facility cited for violation of California Code of Regulations, Title Division Six, regulation 80087(a), Buildings and Grounds. The facility shall be clean, safe, sanitarty and in good repair at all times for the safety and well-being of clients, employees, and visitors. LPA observed a shattered TV glass in the living room mounted on the wall. The licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. LPA issued a plan of correction. LPA cleared the plan of correction on December 13, 2021. The home is within Title 22 regulation standards at this time. There are no deficiencies cited at this time. An exit Interview was conducted, and a copy of this report will be emailed to the facility.

met_with: Tianna Gammage - House Lead


summary: Facility Evaluation

raw_content:
Narrative:
On July 21, 2022 at 1:50pm, Licensing Program Analyst (LPA), Daphne Edison made an unannounced visit to People's Care Garth to conduct a Case Management (other) at the above location. LPA met with Rukiyat Adams, Administrator who granted access to the facility and together a tour was conducted. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory only. Only two (2) children may be non-ambulatory. There is no swimming pool or bodies of water on the premises. The census on the day of this visit is one (1). The home is a single-family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, a living room, dining area, kitchen, laundry area, a detached garage and backyard. Bedroom #1: Occupied. Equipped with a full-size bed and adequate drawer and closet space. Bedroom #2: Vacant. Equipped with a full-size bed and adequate drawer and closet space. Bedroom #3: Vacant. Equipped with a full-size bed and adequate drawer and closet space Bedroom #4: Vacant. Equipped with a full-size bed and adequate drawer and closet space Bathroom #1: Equipped with a toilet and tub/shower combination. Clean, sanitary, and in good operable condition. Bathroom #2: Equipped with a toilet and walk-in shower. Clean, sanitary, and in good operable condition. Continued on LIC 809-C Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA observed non-perishable foods for one week and perishable food for two days. The living room and dining room area has adequate seating capacity. All trash cans have tight fitted lids. All beds are in good repair. The medications are locked above the washer and dryer cabinets and accessible only to employees supervising stored medications. The home has a first aid kit stored above the washer and dryer, the fire extinguisher is located to the side of the washer and dryer fully charged. Disinfectants and poisons are inaccessible to the children in care they are kept locked below the kitchen sink. All knives and sharp objects are made inaccessible to the children in care locked in a cabinet and storage room who only staff members have access to. There are no guns/weapons in the home. Hot water temperature was tested and is within a safe range. All smoke detectors and carbon monoxide tested audible and are operable. There is a working telephone line available for clients to use. The yard is free of debris and hazardous material. LPA observed a basketball court and trampoline. The garage is currently being used as an office space with desks, computers, and cabinets. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Facility vehicle used to transport clients is a Ford Transit in good operating condition. Facility vehicle has current and valid vehicle registration and automobile insurance. LPA requested a copy of the LIC 500. Administrator provided the requested LIC 500 to LPA. Administrator stated will email LPA an updated resume regarding supervisory experience for review of Administrator qualifications. LPA advised Administrator that a written request for an exception can be made to Community Care Licensing if Administrator qualifications of experience and/or education are not met. Continued on LIC 809-C Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted and a copy of this report will be emailed to the Administrator.

met_with: Rukiyat Adams-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2022 at 2:13pm, Licensing Program Analyst (LPA), Daphne Edison made an unannounced visit to People's Care (Garth) for the purpose of conducting a Case Management for Referral 1438-6953-9391-4149358. LPA met with Tianna Gammage, Facility Manager and discussed the incident. During this investigation, confidential interviews were conducted. LPA requested and was provided a copy of the current LIC 500 from the Facility Manager. LPA requested a copy of the Special Incident Report regarding the incident. Facility Manager stated will advise Administrator to email LPA requested document. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 2, Licensing Program Analyst (LPA), Deborah Lee and Licensing Program Manager (LPM) Lakescia Smith, arrived at the home at 9:00am to conduct an unannounced Annual/Required inspection at People's Care Garth. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory. Only two (2) children may be non-ambulatory. Currently there is one (1) child residing in the home. There is no swimming pool or bodies of water on the premises. LPA met with Tianna Gamage, House Manager, who granted access into the home. Thereafter facility Administrator Vera Adidi arrived to facility to assist with inspection Group Home overview: The home is a single family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, a living room, dining area, kitchen, laundry area, a detached garage and backyard. Living room: is equipped with couch, two lounge chairs, a TV with protection screen, table. Dinning area is equipped with round dinning table that seats six (6). Kitchen is equipped with stove, microwave, double door refrigerator, and a dishwasher. There is a washer and dryer located off of the kitchen. Bedroom #1 vacant and has a full size bed, closet space and storage space. Bedroom#2: vacant and has a full sized bed, close and drawer space, Bedroom 3: vacant and has a full sized bed closet and drawer space and 1 chair. Bedroom 4 is occupied by 1 client and has a full sized bed, closet and drawer space and 1 chair. Continue on next page Overall, the home appears to be clean, safe, and sanitary. LPA observed non-perishable foods for one week and perishable food for two days. All trash cans have tight fitted lids. The medications are locked above the washer and dryer cabinets and accessible only to employees administering and supervising stored medications. The home has a complete first aid kit and manual stored above the washer and dryer, there are 2 fully charged fire extinguisher(s) located in kitchen and garage areas. All cleaning supplies and knives are locked away and inaccessible to the children in care. There following activities were available for clients: basketball hoop, trampoline, arts and crafts supplies, and indoor swing. The backyard area is free of hazard materials and debris. The passageways and porches are unobstructed. LPA observed all windows operable. Personal Rights, menu, activity schedule and license are posted. Per the CCL's personnel summary report, there were several staff without a complete criminal record clearance. Administrator Vera stated most of the staff do not work for the facility except 2, however LPA will research guardian to verify clearances for the two staff. Per Vera, staff Tianna and Josephine received a clearance however it wasn't reflected on CCL Personnel Summary. LPA received a copy of clearance letter for Josephine. Exit interview was conducted and a copy of this report will be emailed to the facility

met_with: Vera Adidi


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2023 9: AM, Licensing Program Analyst LPA Deborah Lee and LPM Lakescia Smith made an unannounced to People's Care Garth for the purpose of conducting an Case Management Annual Continuation Inspection. LPA met with Tianna Gammage, House Manager, who granted access into the home. During the inspection, LPA conducted the following: Staff Interviews: LPA's conducted a confidential interview with two (2) on-duty staff members. No client interview was conducted due to client's non-verbal status. Staff files: LPA completed (5) staff file reviews. Per view of of files, they met current licensing requirements. Client files: LPA completed one (1) client file review. LPA observed that client's immunization was not in file, however Administrator was able to obtain copy from Placement agency and placed in client's file at time of visit. LPA reviewed the following logs: fire drill, ongoing training, and communication log. LPA and LPM checked and verified staff Tianna Gammage have a criminal record clearance in DOJ, FBI, and Child Abuse per LIS on 11/6/23. LPA conducted a second walk through to follow up on the Technical Violations issued on 11/2/ The following was observed during today's visit: Screens replaced in bedroom 2 and bathroom 2. Stove was operable, curtains ordered for bedroom 1 and 2. Copy of receipt for curtains provided to LPM. Closet doors removed from Bedroom 3. Follow up needed for broken porch screen in the back yard area. New couch ordered will be delivered approximately 11/14/23. There were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report will be emailed to Facility Administrator.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On September 27, 2022 at 1:37pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care Garth for a Case Management (Other). The purpose of this visit is to ensure staff meets Administrator qualifications. LPA met with Vera Adidi, Administrator who granted access into facility. The group home is licensed to care for four (4) developmentally disabled children, ages 12- 17 years, ambulatory and non-ambulatory only. Only two (2) children may be non-ambulatory. There is no swimming pool or bodies of water on the premises. The census on the day of this visit is two (2). The home is a single-family home located in a residential neighborhood. There are four (4) bedrooms, two (2) bathrooms, a living room, dining area, kitchen, laundry area, a detached garage and backyard. Overall, the home appears to be clean, safe, sanitary, and in good repair. LPA observed non-perishable foods for one week and perishable food for two days. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. LPA requested a copy of the LIC 500. Administrator provided the requested LIC 500 to LPA. LPA discussed Administrator Qualifications and provided a list of documents/forms needed to appoint a new Administrator to the interim Administrator. LPA informed Administrator that staff without Criminal Record Clearance may not provide direct care for clients in care until staff has been associated to People's Care Garth. Continued on LIC 809-C Facility cited on the attached LIC 809-D for violation of California Code of Regulations, Title 22, Division 6, regulation 84064 (e)(1)(A)(B)(C)(D) Administrator Qualifications and Duties. Administrator does not meet education/experience requirements to be designated as Administrator for the facility. Facility cited on the attached LIC 809-D for violation of California Code of Regulations, Title 22, Division 6, regulation 80019(e)(2) Criminal Record Clearance. Staff does not have criminal record clearance to associated facility. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 80054(b), Penalties. Notwithstanding Section 80054(a) above, an immediate penalty of $100 per cited violation per day for a maximum of five (5) days shall be assessed if any individual required to be fingerprinted under Health and Safety Code Section 1522(b) has not obtained a California clearance or a criminal record exemption, requested a transfer of a criminal record clearance or requested and be approved for a transfer of an exemption as specified in Section 80019(e) prior to working, residing or volunteering in the facility. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Deficiencies:
84064: (B) Have a bachelor's degree from an accredited college or university, plus at least one year of administrative experience or supervisory experience over social work, child care, and/or support staff providing direct services to children in an agency or in a community care facility with a licensed capacity of seven or more.
80019: (2) Request a transfer of a criminal record clearance as specified in Section 80019(f).

met_with: Vera Adidi-Administrator

title: Administrator Qualifications and Duties (e)(1)The administrator of a facility with a licensed capacity of 12 or fewer children shall meet the following requirement

title: Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


summary: Facility Evaluation

raw_content:
Narrative:
On March 7, 2023 at 1:29pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Vera Adidi, Administrator. The purpose of this visit is a case management for the complaint allegation, Staff choked minor (34-CR-20221128170842). During the investigation, confidential interviews and statements from staff did not reveal whether the incident on November 27, 2022 was submitted as a law enforcement Special Incident Report (SIR) to Community Care Licensing (CCL). According to statements and documentary evidence received involving the incident on 11/27/2022, law enforcement was called to the facility. Although the facility reported the incident to Westside Regional Center, the incident was not reported to CCL per Title 22 regulations. Due to facility staff not reporting the incident to CCL as a law enforcement SIR, the following deficiency is cited. LPA provided Administrator with Provider Information Notice (PIN) 17-11-CRP, 17-08-CRP, and CCL Informational Memo 2015-04. Facility cited on the attached LIC 809-D for violation of California Code of Regulations, Title 22, Division 6, regulation 80061(b) Reporting Requirements. Facility did not submit a law enforcement Special Incident Report to Community Care Licensing (CCL) per Title 22 regulations. Appeal rights were discussed with Administrator. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.


facility_name: PEOPLE'S CARE KENNETH

raw_content:
Narrative:
Although there was something that could be described as an inappropriate interaction that took place between the referenced clients, this occurred from a distance--with no physical contact being made between the two youths. No other children were present in the area, and a direct-care staff witnessed the interaction and put a stop to it, immediately, by sending the clients to each of their rooms. There was no prior behavior exhibited by the children for the facility to have reasonably anticipated this incident; and no subsequent incident has taken place since. The children interviewed corroborated in describing the level of care and supervision they receive in the facility as more than sufficient. The assigned probation officer reported no concerns regarding the facility's ability to care for and properly supervise children. Based on LPA's observations and interviews, the preponderance of evidence standard has not been met; therefore, the allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Title Regulations were cited as a result of this investigation. Exit interview conducted; a copy of this report and of the Appeal Rights is being provided to the facility.

Investigation Findings:
13On 10/04/2021, at approximately 4: PM, Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection at this facility to close this complaint investigation and deliver the findings. LPA was met by Ashley Johnson, Direct-Support Professional House Lead, with whom the report was discussed. LPA investigated the allegation, Minor engaging in inappropriate interactions with other minors in care. Prior to this LPA taking over, LPA Ashley King was originally assigned to, and opened, the complaint investigation. On 09/16/2021, LPA Cabigon conducted an unannounced onsite inspection to continue the investigation: LPA conducted interviews with two facility youths and staff; one other child refused to be interviewed, and the remaining client was not able to engage in conversation due to a developmental condition that is not conducive to a meaningful interview; LPA also toured the interior and exterior areas of the Group Home's physical plant and observed no Building & Ground deficiencies. On 09/17/2021, LPA Cabigon interviewed an involved Probation Officer via phone. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 10/04/2021

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Ashley Johnson, House Lead


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The allegation that the facility is not properly maintaining a record of C1's medications and medication orders, LPA Hill reviewed the medication binder at the facility containing the Centrally Stored Medication Log, Medication Administration Records (MAR) and prescriptions at the facility. LPA Hill discussed with Mr. Avila that the records do not include physician's orders for the medications as required. LPA Hill also discussed that the prescription numbers are not consistent with the MAR and the facility is not utilizing the required Psychotropic Medication Administration Record (PMAR) as required. LPA Hill informed Mr. Avila that the records have to also show when a prescription begins and when another ends. At this time, the way that the facility is documenting the administration of the medications is not clear about this. The allegation that a lack of supervision causes threat to a child in care is related to an incident that happened on 2/14/23 in which C1 may have touched C2 inappropriately in C2's bedroom. During this incident, investigation shows that the facility had only one staff working despite knowing and understanding that C1 is required to have a 1:1 staff person. The facility did not provide the 1:1 supervision necessary for C1 resulting in the inappropriate interaction. The 1:1 is clearly documented in the client's Individual Program Plan (IPP) maintained by Alta California Regional Center and all staff clearly understand the required supervision needs and reasons. As a result of the confidential interviews, investigation conducted and documentation received, the allegations that a child was left unsupervised, the facility is not properly maintaining medication administration records and that a lack of supervision causes threat to a child in care are SUBSTANTIATED at this time meaning that the "preponderance of the evidence" standard has been met. Facility was cited for California Code of Regulations, Title Regulation 80078(a) Responsibility for Providing Care and Supervision. The facility failed to provide the supervision necessary to meet the needs of C1; Regulation 80075(b)(6)(D) Health Related Services. The facility shall maintain signed, dated, written orders from a physician for every prescription and nonprescription PRN medication the licensee provides assistance; and Regulation 84072(d) Personal Rights. The facility shall ensure that clients in care have the right to live in a safe and comfortable home, including to be protected from harm. Exit interview was conducted and documentation was provided at the conclusion of the inspection along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 3/2/23 at 1: PM and met with Abe Avila, Regional Director to discuss the allegations and findings. LPA Hill informed Mr. Avila that the investigation included an initial inspeciton on 2/6/23 where documentation was requested. LPA Hill interviewed staff, C1's (see LIC811 dated 3/2/23) regional center representative, biological mother to C1, and reviewed C1's documentation at the facility. Regarding the allegation that child was left unsupervised at the facility, Licensing received an incident report dated 2/2/23 detailing that C1's mother reached out to a facility representative about C1 being at the facility alone and without staff. Interview with C1's mother corroborated this information. In addition, the facility was not locked and the facility was accessible to C1 on this date. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 03/02/2023

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Abe Avila, Regional Director

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
The allegation that the facility is using the incorrect medication log is related to the facility administering psychotropic medications to clients in care and not using a Psychotropic Medication Administration Record (PMAR), LIC622B, or similar form which contains all the information as required by Health and Safety Code Section 1507.6(b). The facility not using the appropriate PMAR was discovered and cited during an annual inspection conducted on 7/6/22 and again on 3/13/23 during another annual inspection. Civil penalties were assessed for repeat violation on 3/16/23, as a result of the facility still not using the required PMAR for administration of psychotropic medications. Facility has since implemented the use of the PMAR and have trained their staff on this. In addition, the facility did not have written authorization from the parent/guardian for administration of psychotropic medications. As a result of the investigation conducted by the Investigations Branch and observation(s) by LPA Hill, the allegations that facility does not maintain required ratios for high need clients and that the facility is using the incorrect medication log are SUBSTANTIATED at this time meaning the "preponderance of the evidence" standard has been met. Because these issues were recently observed, citations issued, and have since been corrected, the Department is not citing the facility at this time. Exit interview was conducted and documentation was provided to the facility. no proof that C1 exchanged inappropriate photos with adults or other individual(s) online. Staff interviewed denied witnessing C1 in the chat room or witnessing C1 exchange any inappropriate photos while using the facility's computer. The facility's technology staff have since blocked access to cites that have been identified as inappropriate or unauthorized. As a result of the investigation and interviews conducted, the allegation that C1 exchanged inappropriate photos with an adults online and joined multiple adult pornographic sites is UNSUBSTANTIATED at this time meaning that allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. No citations were issued at this time. Exit interview was conducted and documentation was provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 5/17/23 at 12: PM and met with Diane McGill, Administrator to discuss the complaint findings. LPA Hill informed NAME that the investigation included an initial inspection on 2/16/23 followed by the Department's Investigations Branch complete investigation. The investigation was conducted by Investigator Andrew Murrow. The allegation that the facility does not maintain required ratios for high need clients is related to the facility acceping clients that need additional supervision or the one staff to one client ratio (1:1) and not providing the staffing to meet that need. Investigation showed that C1 (see LIC811 dated 5/17/23) required a 1:1 staff person supervising them and since there were two clients in the facility there should have been a minimum of two staff persons at all times but the facility did not provide that level of staffing as needed. This was observed and cited during a case management inspection to the facility on 3/16/23. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/17/2023

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Diane McGill, Administrator


raw_content:
Narrative:
The Department has investigated the complaint allegations that youth trespasses onto neighbor's property and youth vandalizes neighbor's house. During confidential interviews, staff disclosed that they were not comfortable with dealing with C1's behaviors and needed more training. Staff also disclosed that they were told to perform an intervention that was not a part of their emergency intervention training. When LPA Goldie asked about C1 possibly leaving from his bedroom, staff stated that C1 sleeps with his door closed and egress alarms on the window/door, but they were broken for two weeks. Record review of Ring video clips provide visual evidence that C1 trespassed onto neighbor's property and broke the porch light on multiple occasions. Seven videos from 02/12/2024- 02/18/2024 reflect C1 trespassed onto neighbor's front porch and vandalized porch light without staff present on 02/12, 02/14 x 2, 02/15, 02/16 and 2/26 x 2. Based on observation, confidential interviews conducted and record review(s), the complaint allegations are SUBSTANTIATED. An allegation that is considered valid because the preponderance of the evidence standard has been met. The facility is being cited for violation of Title Division 6, Chapter 1, Article 6 80078 (a) Responsibility for Providing Care and Supervision. (See LIC809D) An exit interview was conducted with Name , Title. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13An unannounced complaint investigation was conducted byLicensing Program Analyst (LPA) Connie Goldie on 04/04/2024 at 11: AM. During the inspection, LPA met with Ashley Johnson, Program Administrator to discuss the findings of the complaint allegations LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Connie Goldie, at the facility on 02/26/2024 which included a physical plant inspection, 2 staff interviews and a record review of C1's file. LPA Goldie requested C1's face sheet, Individual Program Plan, T-logs for February 2024 and current Behavior Intervention Plan, staff roster, including staff contact information and schedules for the month of February 2024. During the course of the investigation, LPA Goldie interviewed five staff and one witness. LPA conducted record reviews on 03/07/2024 and 03/25/2024 of Ring video clips recorded between 02/12/2024 and 03/25/2024. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 04/04/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Administrator Ashley Johnson


raw_content:
Narrative:
The Department has investigated the complaint allegation that client sustained an unexplained injury while in care. During confidential interviews, two of two staff present with C1 at Urban Air Adventure Park corroborate that a male individual approached C1 and hit him while he was in line for an attraction. Staff stated that they got in between aggressor and C1 to stop the assault. W1 who assisted with the incident corroborated that two staff were present with C1 when the attack occurred. However, C1 broke a laptop that belonged to the aggressor's niece before this incident occurred while staff were exiting the previous attraction line. Because the staff made the decision to participate in the zipline activity, line of site supervision was not maintained. Record review of video verifies the staff did not observe the property destruction and therefore, did not intervene prior which allowed for client to suffer an injury while in care. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, 84078 (b) Responsibility for Providing Care and Supervision are being cited on the attached LIC 9099D." LPA spoke with District Manager, John O'Brien on the phone to obtain plan of correction. An exit interview was conducted with Rayanna Grayson, House Lead. A copy of all reports and appeal rights were discussed and provided to the facility.

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 05/01/2024 at 12: PM. During the inspection, LPA met with Rayanna Grayson, House Lead, to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Goldie, at the facility on 03/27/2024 which included a physical plant inspection, a staff interview, and a record review of C1's file. LPA Goldie collected C1's updated Individual Program Plan (IPP), Updated Quarterly Report, T log for 03/15/2024 and Emergency Room documentation for visit on 03/15/2024. During the investigation, LPA Goldie interviewed three staff, C1's Service Coordinator, and one witness. LPA Goldie conducted a record review on 04/04/2024 of C1's Incident Report dated 03/15/2024, video clip at Urban Air Adventure Park, C1's Individual Program Plan updated in February 2024, C1's Quarterly Report, T log notes, and Emergency Room documentation. The client was unable to be interviewed as he is non-verbal. Continued on LIC9099D SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/01/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Rayanna Grayson, House Lead


raw_content:
Narrative:
The Department has investigated the complaint allegation that staff do not provide adequate supervision to a minor. During confidential interviews, six of six staff corroborate that C1 was followed by at least two staff each time he eloped and at times during elopement he was unsafe when running in traffic. Five of six staff state C1 was in imminent danger during elopements. One of six staff stated, "I don't know what imminent danger is." Six of six staff stated a restraint can't be utilized on a client. The following statements were made, "What can we do? This is a children's home," and "We can't put hands on them." The facility's Program Statement states in the Run Away/ Emergency Intervention Plan section "If a child is in imminent danger, physical containment according to CPI will be utilized." Record review of incident reports indicate that C1 ran in and out of traffic on busy streets, entered a body shop with hazards -cars hanging and stayed for over an hour and grabbed scissors and began threatening others. Staff called law enforcement for assistance. Staff did provide supervision to C1 but, did not follow their program statement when imminent danger occurred which made it inadequate supervision to meet the client's needs. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 5, Plan of Operation 80022 (k) are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were provided and discussed with agency representative.

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 05/17/2024 at 03: PM. During the inspection, LPA met with Rayanna Grayson, House Lead to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Goldie, at the facility on 01/30/2024 which included a physical plant inspection, two staff interviews, a client interview, and a record review of C1's file. LPA Goldie collected C1's Individual Program Plan (IPP), Behavior Intervention Plan, admission agreement, staff roster, staff schedules for 01/15/2024-01/25/2024 and CPI certificates. During the investigation, LPA Goldie conducted ten confidential interviews between 01/30/2024 and 05/08/2024. LPA Goldie conducted a record review on 04/22/2024 of C1's Roman Empire progress report, START family crisis plan, Individual Program Plan, and facility Program Statement- Runaway plan- Emergency Intervention Plan. C1 declined to be interviewed and C3 was unable to be interviewed as he is non-verbal. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/17/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Rayanna Grayson House Lead


raw_content:
Narrative:
The Department investigated the allegation, Facility staff are not providing adequate one on one supervision to a client in care. Three of five staff members interviewed stated that they were trained on one-to-one supervision expectations. Two staff members present during the incident declined to be interviewed and are no longer employed by the facility. A witness and a staff member corroborated that S4 did not maintain the necessary supervision required for C1. The incident report submitted to the Department also stated C1's staff, (S4) "got up from line of sight with C1 and went to the kitchen to grab something." Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 84078(b) Responsibility for Providing Care and Supervision are being cited on the attached LIC 9099D." The facility is being assessed a Civil Penalty for a repeat violation within 12 months as the facility was cited for this regulation violation on 05/01/2024. Administrator Diane McGill provided plan of correction by telephone. An exit interview was conducted. A copy of all reports and appeal rights were provided and discussed with agency representative.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 06/27/2024 at 12: PM. LPA Goldie spoke with Rayanna Grayson House Lead to discuss the findings of the complaint investigation and allegation stated above. LPA Goldie informed agency staff this case was investigated by Licensing Program Analyst Connie Goldie. The initial 10-day complaint investigation inspection at the facility was conducted by LPA Connie Goldie on 04/22/2024. At the facility, LPA Goldie reviewed a youth file and interviewed a staff. LPA Goldie obtained the following documentation: C1's updated Individual Program Plan (IPP), C1s face sheet, C1's T log and staff schedule for 04/17/2024. During the investigation, six confidential interviews were conducted between 04/22/2024 and 06/19/2024. C1 was not interviewed as he is non-verbal. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 06/27/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


raw_content:
Narrative:
Regarding the allegation, Client was left alone in facility, W1 said C1 told her he was left home alone but also stated C1 doesn't always tell the truth. C1 denied being left at home alone. All staff interviewed corroborate that clients have not been left alone in the facility. However, confidential interviews reveal that C2 has been left alone at the facility due to staff being unaware of the minimum school day schedule on more than one occasion. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division Chapter 1 80078(a) Responsibility for Providing Care and Supervision are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were provided and discussed with agency representative. The Department investigated the allegation, Staff were fighting in the facility. One of five staff members interviewed stated a member of the staff will have random verbal arguments with others and will do it regardless of who is present. No other staff corroborated this statement. One youth said sometimes a staff will have a "mean tone" with each other and the other youth said staff joke with each other. Due to lack of evidence, this allegation is found to be 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." Regarding the allegation, Management are not adequately addressing serious incidents, one youth and one staff corroborated that staff did have verbal disagreements with one another. The District Manager stated that it was brought to the attention of the Administrator that S4 was aggressive with body language and assertive with tone which was identified as inappropriate. The staff, (S4) was placed on administrative leave on 05/14/2024 and terminated shortly thereafter. Although staff did act inappropriately, management did follow up on this issue and did address the concerns. It has been brought to the Department's attention through previous interviews that multiple issues of concern have come up and it has been perceived that they were not handled in a timely manner. 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 all reports and appeal rights were provided and discussed with agency representative.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 06/27/2024 at 12: PM. LPA Goldie spoke with Diane McGil Program, Administrator to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed agency staff this case was investigated by Licensing Program Analyst Connie Goldie. The initial 10-day complaint investigation inspection at the facility was conducted by LPA Connie Goldie on 04/22/2024. At the facility, LPA Goldie reviewed a youth file and interviewed a staff member. LPA Goldie obtained the following documentation: C1's Individual Program Plan (IPP), C1 and C2's face sheets, C1's T log for 03/25/2024 and staff schedules for 03/17/2024- 04/27/2024. During the investigation, eight confidential interviews were conducted between 04/22/2024 and 06/19/2024. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 06/27/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Diane McGil Program, Administrator


raw_content:
Narrative:
Regarding the allegation, "Staff sent a minor that has signs of illness to school", a youth stated, "I went to school some days when I was sick with a fever." W3 corroborated C1 went to school multiple days when sick with a significant cough and when school called group home, the staff challenged the need to pick C1 up on more than one occasion. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 84072(d)(1) Personal Rights are being cited on the attached LIC 9099D." An exit interview was conducted. A copy of all reports and appeal rights were provided and discussed with agency representative. The Department investigated the allegation, Staff did not administer medication to minor. C1 was taken to their primary care physician by bio mom on 05/06/2024 and received a prescription. Immediately afterwards, C1 returned to the facility with the prescription. C1 was unable to immediately receive medication to assist with the symptoms. Four of four staff members interviewed stated that to administer medication to a client a Medication Administration Record (MAR) must be completed, and a prescription verified which is in alignment with the facility's Program Statement. A MAR was created, and the prescription was verified with the pharmacy and then C1 received the medication. A time lapse occurred as a result of needing to create a MAR and verify the prescription with the pharmacy. 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." The Department investigated the allegation, Staff did not seek medical attention in a timely manner. C1 and staff corroborate that C1 started coughing around 05/01/2024. S1, S2 and S3 provided inconsistent statements about policy on how to respond to a client who is exhibiting symptoms. One staff stated they didn't 100% know what the policy was regarding seeking medical care for a sick client. C1 was taken to Urgent Care on 05/04/2024 by a House Lead. LPA is unable to determine based on interviews if the timeframe was best for C1. 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 all reports and appeal rights were provided and discussed with agency representative.

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the facility to conduct an unannounced complaint investigation inspection on 07/31/2024 at 12: PM. LPA Goldie spoke with Vanessa Baldwin, Administrator Interim and Rayanna Grayson, House Lead to discuss the findings of the complaint investigation and allegations stated above. The initial 10-day complaint investigation inspection at the facility was conducted by LPA Connie Goldie on 05/04/2024. At the facility, LPA Goldie reviewed a youth file and interviewed a staff member. LPA Goldie obtained the following documentation: C1s face sheet, medical documentation and C1's Individual Program Plan. During the investigation, ten confidential interviews were conducted between 05/14//2024 and 07/29/2024. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 07/31/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Vanessa Baldwin Administrator Interim Rayanna Grayson House Lead


raw_content:
Narrative:
The Department did not receive any SIRs regarding the minor in care leaving the facility on the date in question. Three out of four interviews stated that no staff member has ever come to work under the influence of alcohol and if they would have, they would have reported it immediately to the police and the Administrator. Three out of four interviews stated that staff do not use restraints on the minor in care and on December 31, 2024, the client stated that he was not restrained and has never been restrained at the facility. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview and appeal rights were discussed with Schirrell Ellison, DSPII and Arneatha Simon who was on the phone to hear the findings. A copy of this report along with the appeal rights were given to Schirrell Ellison, DSPII.

Investigation Findings:
13On May 30, 2025 at 9: AM, Licensing Program Analyst (LPA) Michelle Silvas initiated an unannounced complaint investigation inspection at the above listed facility. LPA met with Schirrell Ellison, DSPII, who assisted with the inspection. The purpose of the inspection was to deliver findings for the above listed allegations. 1 staff and 1 client are present. LPA conducted the initial 10-day complaint investigation at the facility on February 18, 2025. LPA conducted Four confidential interviews between 2/18/25 - 3/28/25. It was alleged that staff did not adequately supervise minor resulting in minor leaving the facility, staff was under the influence of alcohol while providing care and supervision to minor, and staff used inappropriate restraint on minor. Three out of four confidential interviews stated that the minor in care did not leave the facility on December 31, 2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Michelle Silvas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: 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 Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/30/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Schirrell Ellison, DSPII


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA), Stefanie Whitlow, discovered that a staff member, initially trained at the Kenneth House People's Care Group Home, had been expected to administer medication to clients prior to receiving adequate training. LPA interviewed the staff member, who disclosed feeling uncomfortable administering medication because they had only job shadowed prior to being expected to administer themselves. This does not meet the expectations outlined in the facility program statement training procedures. LPA advised administrator, Pauletta Hendrix, of medication administration training regulations and the expectation that staff training aligns with the facility plan of operation. The plan of operation states that medication training, "includes instruction in maintaining a medication log, using sterile procedures, proper storage of medication, dosage, frequency and times of administration, reasons for medications and possible side effects." No citations are being given at this time. Exit interview was completed virtually with administrator on 6/14/21 at 10:30 am.

met_with: Pauletta Hendrix


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analysts (LPA) Alyssa Burgess and Shawndra Miles made an unannounced annual inspection at the facility and met with staff Helena George who assisted with this inspection. Later in the day, Facility Manager Ashley Johnson arrived, who also assisted with the inspection. LPAs and staff George conducted a walk-through of the facility. LPAs observed a kitchen, living room, dining room, garage, two bathrooms, 1 staff office, 4 client bedrooms, the backyard, and closets. LPAs observed one client bedroom to have a hole in the wall, and the smoke detector broken and hanging, as well as the light in the hallway broken and hanging. Also in this room the blinds were broken. In one of the bathrooms, the windows was broken, with glass scattered on the ground outside. These areas of disrepair are due to one client's behaviors when escalated. One hole in the wall was found in the living room The facility had already put in for repairs of these issues to their maintenance team. During this inspection, the hanging smoke detector and light in the hallway were repaired. Staff did sweep up as much of the glass as possible, however the broken window remained uncovered. Staff stated the window has been broken since 6/25/2022. LPAs observed an adequate amount of perishable and non-perishable foods, including fresh fruits and vegetables. LPAs observed clients to have an adequate amount of clothes and other items they need for daily living. All first aid supplies were present except for the scissors and adhesive tape. Proper toiletries were available. The water in the client's bathroom measured at 99.4 degrees Fahrenheit, which is below the required minimum temperature of 105 degrees Fahrenheit. LPA is advising the facility to slightly raise the temperature of the water heater to bring it within the required range of 105 - 120 degrees Fahrenheit. All clients had proper bedding supplies, however one client's bedding was not clean. That client is in charge of their own laundry. Personal rights, the License, and other documents were posted as required, however the complaint procedures were not. The facility vehicle appeared to be in fair condition however there were some warning messages when turning it on. When reviewing the latest service paperwork, there were some recommendations on there from the auto-shop. LPA is unable to determine whether or not the vehicle is in proper working condition from this inspection, however issued an advisory note advising the facility to get confirmation on this. The facility does have a phone available for use as required however it is not set up in a way that the clients may make or receive confidential phone calls. The phone is corded and in the staff office, which staff informed LPA that a staff has to be present in the office at all times a client is in there. LPAs conducted interviews with four staff about general facility and program information. Board meeting minutes were requested, however LPA did not receive them on this date. On this date, the facility is being cited for violations of the California Code of Regulations (CCR), Title 22, Division 6, Sections: 84087.2(a), 84072(d)(8), and 80044(a). LPA also issued advisory notes, which are not citations for CCR sections: 80075(g)(1), 80088(e)(1), 84487(d)(3)(A), 84072.2(a)(3), 80074(c). An exit interview was conducted with Facility Manager Ashley Johnson, and a copy of this report and appeal rights was emailed to her with a read receipt which will serve as the record of receipt.

Deficiencies:
80044(a): Deficient Practice Statement
1
2
3
4Based on staff statements and observation the licensee did not comply with the section cited above when only one staff has access to the client files, and that staff was not present until 2:30 PM which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2022
Plan of Correction
1
2
3
4

met_with: Helena George, Ashely Johnson

title:
Inspection Authority of the Licensing Agency

(a) The licensing agency shall have the inspection authority specified in Health and Safety Code Sections 1526.5, 1533, 1534, 1538 and 1538.7.

This requirement is not met as evidenced by


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Licensing Program Analysts (LPA) Alyssa Burgess and Shawndra Miles made an unannounced annual inspection at the facility and met with staff Helena George and Administrator Pauletta Hendrix who assisted with this inspection. LPAs reviewed nine staff files, one Administrator file, and four client files. LPAs also interviewed two clients. The other two clients were not able to communicate effectively to be interviewed. All client and staff files were accessible to LPAs. Board Meeting minutes were not provided, which were originally requested on 6/28/2022. Psychotropic medications were not separated on separate forms as required, and there were no psychotropic medication authorized representative consents for any of the minor clients. LPA reviewed the CCL Psychotropic Medication Administration Record with Administrator and offered it as an option for them to use, or they can ensure the pharmacy is informed of the changes they need to make to be in compliance. LPA found no evidence of clients having been to a dentist or a doctor as required for general check ups, although Administrator explained the clients' parents do take them, they just have not sent in any of the paperwork. There were also no records of TB tests for three out of four clients. LPA found that clients are not receiving allowances as required. This issue was brought up and cited at two other People's Care Homes - Shawmutt and Pleides previously. A POC was submitted by the Director of Quality Assurance and Development (DQAD) on 1/24/2022 which detailed how the facility would ensure clients received a certain amount of money each week. DQAD submitted that correction for this house, Kenneth, as well. The facility is not following this plan. LPA has advised the Administrator that this is a requirement for all of People's Care licensed children's residential facilities and advised upper management to correct this in all of their homes state-wide to prevent future citations. The facility had a staff schedule as required, and had scheduled facility managers as required. Even though facility managers have received the required one hour training, there was no documented evidence of this. There were various other things missing or incorrect, which LPA detailed in the attached Technical Violation Advisory Notes, which are not citations. On this date, the facility is being cited for violations of the California Code of Regulations (CCR), Title 22, Division 6, Sections: 84063(a), 84070(b)(12), 80069(a), 84070(b)(13), 80069(c)(1), 84077(a)(2), and 84478(f). An exit interview was conducted with the Administrator and a copy of this report was emailed to her with appeal rights and read receipt which will serve as the record of receipt.

Deficiencies:
84063(a): Accountability

(a) The board of directors shall be active in ensuring accountability, and shall perform, at a minimum, the following duties


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection on 2/16/23 at 11: AM and met with staff Rhynada Long, DPS 1 to discuss an incident that took place on 2/14/23. Staff states that she was not here for the incident so a call was placed to the administrator Diana McGill who spoke with LPA Hill about the incident. Ms. McGill provided that the incident involved two clients in a room together and a subsequent unauthorized absence for one of the clients involved. LPA asked that Ms. McGill provide documentation related to the client's needs to include the Individual Placement Plan (IPP) for the clients in care. LPA Hill informed Ms. McGill that further follow up is needed at this time and that Licensing may conduct additional investigation into this matter. While conducting the walk through of the facility, LPA Hill observed a leak under the bathroom sink. LPA Hill advised that this needs to be addressed right away. LPA Hill observed that the other bathroom sink is slow to drain and also needs to be addressed. No citations were issued during the visit today. End of documentation and document printed and provided to Ms. McGill via email.

met_with: Rhynada Long, DSP 1


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced annual inspection on 3/13/23 at 12 noon for the purposes of conducting an annual inspection. At the time of LPA's arrival, staff Rhynada Long was present and assisted with the physical plant inspection. At the time of LPA's arrival, no clients were present in the facility. LPA Hill toured the facility and observed that there are four single occupancy rooms but that there are only two clients currently in the facility. LPA observed that there are two restrooms in the home and that the water temperature in the restrooms was measured at 90 degrees Fahrenheit and 100 degrees Fahrenheit. LPA observed that the facility had smoke detectors that were functioning as required and that there are two carbon monoxide detectors in the facility. On this date, the facility is being cited for violations of the California Code of Regulations (CCR), Title 22, Division 6, Sections: 84072(a), 80088(e)(1), 84487(d)(3)(A), 84487(f), 80023(a), 84070(b)(12), 84070(b)(13), 84070(c)(12), 84072(a)(3), Health & Safety Sections 1538.5(a)(3), 1565(a), 1565(b). LPA also issued advisory notes, which are not citations for CCR sections: 80076(a)(19), 80087(a), 84009(a), 84087.2(a), 80070(c). An exit interview was conducted with Gina Renteria Quality Assurance Specialist, and a copy of this report and appeal rights was provided during the inspection today.

Deficiencies:
84072(d): Deficient Practice Statement
1
2
3
4Based on LPA's observation, the licensee did not comply with the section cited above in that the measurements of the water temperature in the facility read 90 degrees F in one bathroom, 100 degrees F in the other bathroom, and 98 degrees F in the kitchen which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/20/2023
Plan of Correction
1
2
3
4

met_with: Gina Renteria, Quality Assurance Specialist

title:
Type BSection CitedCCR80088(e)(1)

Fixtures, Furniture, Equipment and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.  (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced annual inspection on 3/14/23 at 10:15 am for the purposes of continuing the annual inspection. At the time of LPA's arrival, staff Rhynada Long and Zahrod Griffin, LVN was present. Gina Renteria, Quality Assurance Specialist and Nelson Rivera, Quality Assurance and Training Specialist also arrived during the inspection today to provide additional assistance. LPA Hill reviewed staff and client files during the inspection on this date. LPA Hill observed that the staff in the facility are fingerprint cleared to be present. LPA Hill observed that the facility has several issues related to documentation in the facility. Those documentation issues are related to staff training, client file documentation, documentation of services provided to clients, and other documented items that are required to be present in client files. LPA and Mr. Avila discussed the need for Technical Assistance to assist the licensee to achieve compliance in the regulations as needed. LPA provided Mr. Avila with confirmation that Technical Assistance can be requested on behalf of the facility to bring the facility into compliance. The facility is being cited for violations of the California Code of Regulations (CCR), Title 22, Division 6, Sections: 84065(j)(6), 84065(f), 84065(d), 84065(i), 84065(n), 84072(d), 84068.1(b)(4)(B), 84077(a)(2), and 80026(h)(1)(A). LPA also issued advisory notes, which are not citations for CCR sections: 84068(b)(1), 80075(b)(5), 80075(b)(4), 84065(b)(1), 84066(b)(1), 80066(a)(8), 84063(a)(8). An exit interview was conducted with Abe Avila, Regional Director, and a copy of this report and appeal rights was provided during the inspection today.

Deficiencies:
84072(d): Personal Rights

(d) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code section 16001.9, as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
84065(i): Personnel Requirements

(i) Notwithstanding Sections 80065(f)(1) through (6), new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training as specified in (1) and (2) below
84065(f): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above in two out of two records reviewed did not have the required documentation related to mental health services or the monthly consultations required which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/21/2023
Plan of Correction
1
2
3
4

title:
Personnel Requirements

(f) The licensee of a group home providing care and supervision to children diagnosed by a physician, psychiatrist, psychologist or licensed clinical social worker as mentally disordered shall make provision for at least monthly consultation from a psychiatrist, or clinical psychologist, or licensed clinical social worker regarding the program of services.

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced Plan of Correction inspection 4/18/23 at 11: AM and met with Diane McGill, Administrator. LPA Hill went through all of the citations that were outstanding and did clean all but two that the administrator states that they currently need to work on. The facility is requesting additional time to work on the facility manager designation in the job duty statements and/or training per 84065(d). The facility is also requesting an extension to work on the employee training handbook as specified in 84065(n). LPA Hill also advised Ms. McGill during the inspection that the facility needs to work on the documentation regarding training in that the proof of training documentation is not clear about topic(s), hour(s) for specific topics on initial new employee training documentation. LPA Hill advised Ms. McGill to go through the Personnel Requirements as specified in Group Home Regulations, Section 84065(d) and document the training as indicated in this section. There are requirements for documenting proficiency in staff's ability to do the assigned job and specific topics to be trained on in the initial eight hour training and other training to be provided within 90 days of hire. Exit interview was conducted with Ms. McGill and documents were provided at the conclusion of the inspection. No additional citations were issued today.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts Tamara Hill, Connie Goldie, and Monica Roberts, Jodean Hall, Licensing Program Manager, Margo Castaneda, Regional Manager all met in the office on 5/9/23 at 1: PM. In attendance for the facility were Kourtney Hamilton, Administrator, Diane McGill, Administrator, Tony Keuter, Chief Executive Officer, Chris Trevilla, Director of Compliance and Training, Abe Avila, Regional Director, and John O'Brien, District Manager. Attending via video conference were Michelle Minez, for People's Care; Regional Center representatives Jordan Eller, Katie Robert, Ann Ford, Dan Kilmer, Heather Patrick, Rena Mathiesen, and Jacqueline Vicente. Isabel Diego CCLD San Bruno Office was also in attendance via video conference. Discussed during the conference were ongoing issues related to the annual inspection and complaints that were issued within the previous 12 months, including civil penalties as a result of repeat vioaltions. Facility was advised that if compliance is not met then the facility will be referred to the Department's Legal Division for appropriate legal action as applicable. Facility states that they have implemented additional staffing to provide oversight as necessary to improve compliance. The agency has oversight of 99 homes in California that are licensed by CCLD, including day programs, adult residential facilities, and children's residential facilities. Regional Center is going to continue to have their monthly collaborative meetings to ensure compliance and will continue to work with the facility to assist with staffing and other compliance issues. Facility was reminded about accountability by the board for the oversight of the facility and compliance. Exit interview conducted.

met_with: People's Care Representatives


summary: Facility Evaluation

raw_content:
Narrative:
On 10/26/23, at time, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced case management inspection to amend LIC809 issued on 09/14/2023. LPA met with Lixie Ceballos, Direct Care Staff who assisted with the inspection. Alex Jenkins, Behavior Consultant was present in the home and clients were at school. LPA Goldie conducted a tour of the facility with staff Lixie Ceballos and no deficiencies were observed.( LPA Goldie waited for PA to bring a key to open a locked door in home.) LPA Goldie discussed status transition of new Administrator, Ashley Johnson to facility. Current Program Administrator,(PA), Diane McGill, stated transition should be complete in 2- 3 weeks. LPA Goldie provided consultation with Program Administrator. LPA provided a copy of the amended LIC809 document along with a copy of today's LIC809 to facility. Additionally, a copy of appeal rights were discussed and provided.

met_with: Lixie Ceballos Direct Care Staff DSP2 Diane McGill Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On this date, at 01: PM, Licensing Program Analyst (LPA) Connie Goldie conducted a case management inspection at the facility and was greeted by staff Ineca Johnson, (S4) upon arrival. The purpose of the inspection was to inquire about an incident report that was received by the Department on 11/08/2023. LPA called Program Administrator, (PA) Ashley Johnson who stated she was on her way. An Alta Regional Center staff, Dan Kilmer, was present and District Manager, John O' Brien also arrived for the inspection. LPA conducted a walk through of facility. LPA spoke with staff regarding incident report that included several concerns. LPA conducted a record review of 2 clients files and requested copies of Cash resources PNI logs and receipts for money spent for 3 months, C1 and C T- logs for 3 months, Incident Reports, Medication Administration Records (MARs) for 3 months and most recent Individual Program Plans, Activity calendars, work orders, cleaning checklists , menus and logs for change,and grocery receipts for three months. LPA conducted one staff interview. Further investigation is required to resolve the matter. A copy of this report was provided to the facility.

met_with: Ashley Johnson, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/30/2024, at 03: PM, Licensing Program Analyst, (LPA) Connie Goldie made an unannounced subsequent case management inspection and was greeted by Alex Jenkins, Board Certified Behavior Analyst Assistant. The purpose of the inspection was to continue follow-up on an incident report that was received by the Department on 11/08/2023. LPA conducted a walk through of the facility inside and out. No deficiencies were observed. LPA conducted 1 staff interview and one client interview during inspection. Further investigation is required to resolve the matter. A copy of this report was provided to the facility.

met_with: Ashley Johnson Program Administrator`


summary: Facility Evaluation

raw_content:
Narrative:
On 03/08/2024, at 2: PM, Licensing Program Analyst (LPA) Connie Goldie, Licensing Program Manager (LPM) Jodean Hall, and Margo Castaneda, Regional Manager, conducted an informal office meeting via Teams Meeting to discuss the following concerns- Lack of Supervision and Training. Present from Peoples Care is: Christopher Trevilla Director of Compliance Michelle Mainez Chief Operationg Officer, John O'Brien District Manager, Ashley Program Administrator, and Present from Alta Regional Center is: William Hodgson, Facility Liaison and from Aspire Patrick Salmon, BCBA consultant and Janessa Breckley, BCBA . From 02/10/2024 to present the Department has received an increased number of Incident Reports involving C1 vandalizing the neighbor's property (02/10, 02/12, 02/15, 02/16, 02/22 x 2, 02/27, 03/04 and 03/05) and Ring videos of C1's vandalism behaviors of the neighbor's property which has resulted in the client receiving two restraining orders and the Sacramento County Board of Supervisors involvement. The Department acknowledges that facility has since recognized the need to implement new plans and has made efforts to prevent C1 from vadalizing neighbor's property. However, when behaviors began week 1, seven Ring videos have captured C1 without staff present on neighbor's front porch. Based on the records reviewed, and staff interviews, LPA also learned that staff do not feel adequately trained to meet the needs of C1. The Department is requesting in writing a timeline to the Department in of what they have done and intend to do going forward. Additionally, the agency will provide a 3 day notice of C1's relocation due to clients needs exceeding plan of operation. The agency will submit this documentation to the Department on 03/11/2024. No deficiencies will be cited. Exit interview conducted at 03: PM. A copy of the report was provided by email to the Administrator . Continued on LIC809C

met_with: Ashley Johnson Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/28/2024 at approximately 04: PM, Licensing Program Analyst (LPA), Connie Goldie arrived unannounced at Peoples Care Kenneth for the purpose of conducting a Case Management-Incident Inspection. LPA met with Program Administrator, (PA) Ashley Johnson who assisted with the incident inspection. During the Case Management-Incident Inspection, LPA interviewed two staff. Based on interviews and record review, supervision was adequate and crisis communication was utilized as listed in C1's individualized behavior plan. Case management follow-up is complete. No deficiencies were cited during today's Case Management- Incident Inspection. Exit interview was conducted, and a copy of this report was provided to Program Administrator, Ashley Johnson.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/12/2024 at approximately 12: PM, Licensing Program Analyst (LPA), Connie Goldie arrived unannounced at Peoples Care Kenneth for the purpose of conducting a case management- incident Inspection. LPA met with Program Administrator, (PA) Ashley Johnson who assisted with the incident inspection. All clients are at school. During the inspection, LPA discussed concerns about safety when C1 is in the community as a result of incident report received by the Department on 04/10/2024 for an incident that occurred at Carmichael Park on 04/09/2024. LPA interviewed Administrator to determine how C1's Individual Behavior Plan (IBP) has been adjusted to keep others safe while C1 is on an outing in the community. Administrator stated C1 is only going on van rides and his IBP is being adjusted by C1's Board Certified Behavior Analyst (BCBA) and is expected to be completed by 04/16/2024. LPA obtained most recent IBP for C1 and conducted one interview. Further investigation is required. An exit interview was conducted at 1: PM and a copy of this report was provided.

met_with: Ashley Johnson Administrator