raw_content:
Narrative:
Based on interviews and record reviews the allegations that S1 and S2 did not administer C1's medication and the medication was not logged properly, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Francisco Benavides.

Investigation Findings:
13On July 01, 2021 at 08:20 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA Marisol Lopez conducted a tele-inspection on November 25, 2020 at 11:00 am and no immediate deficiencies were observed. Five staff (S1, S2, S3, S4, S5), zero of four foster children (C1, C2, C3, C4) facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff (S1 and S2) did not administer C1's medication and the medication was not logged properly. Confidential staff interviews reported that C1 has been administering C1's medication according to the prescription and the medication logs are being filled out properly. According to the documentation that was provided to the LPA the medication and logs were filled out according to the prescription directives. LPA attempted to interview all four children but was unsuccessful due to them having limited verbal skills and being unresponsive. The interviews that were provided to the LPA were not consistent and did not provide any further specific details regarding C1's medication. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 08-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, FACILITY NAME: PEOPLE'S CARE FERNVIEWFACILITY NUMBER: VISIT DATE: 07/01/2021

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

met_with: Francisco Benavides


state: CA

facility_name: PEOPLE'S CARE FERNVIEW

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews denied having heard of S1 using inappropriate forms of discipline however, other statements stated the allegation occurred but did not have further details and no witnesses of the incident. Confidential interviews stated S1 is no longer an employee of the facility however the reason for transferring is unrelated to the allegation. Confidential Interviews were attempted with four of four clients, however clients were not able to be interviewed due the inability to comprehend or answer questions. Based on confidential interviews, the allegation that staff #1(S1) used an inappropriate form of discipline may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted and a copy of this signed report was emailed to Program Representative Otilli Abuka.

Investigation Findings:
13On June 01, 2022, at 1:50 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Program Representative Otilli Abuka of People's Care Fernview to discuss the investigative findings for the allegation noted above. On August 25, 2021, at 12:50 p.m., Licensing Program Analyst (LPA) Marisol Lopez and LPA Danielle Garcia met with Program Representative Otilli Abuka to conduct an unannounced initial complaint investigation. LPA's conducted a safety inspection and no deficiencies were observed at that time. During the investigation, LPA Lopez conducted confidential interviews with six staff (S1-S6), one administrator, attempted interviews with four of four clients (C1-C4) and reviewed incident reports. On 08/20/2021, the Department received allegations that staff #1(S1) used an inappropriate form of discipline. It was reported S1 gave C1 a cold shower as a form of punishment. Confidential interviews contradicted the information stating that facility staff as a form of discipline, redirect clients, provide clients with space to return to baseline and provide support to clients to process emotions. (see continuation form LIC9099-C dated 06/1/22) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Marisol Lopez 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 08-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, METROPOLITAN DR. # FACILITY NAME: PEOPLE'S CARE FERNVIEWFACILITY NUMBER: VISIT DATE: 06/01/2022

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

report_type: Complaint Investigation

met_with: Otilli Abuka.

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, June 30, 2021 at 11: AM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At the time of Inspection LPA met with Direct Care Staff Devin Wood. The facility was toured inside and out with Direct Care Staff Devin Wood. The home is a one-story residence with four bedrooms and two bathrooms. There were no clients present at time of inspection. Bedrooms are arranged so that no more than one client is in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in the kitchen measured to be 105.1 degrees, in bathroom one 112.2 degrees and in bathroom two 110.9 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in the kitchen. Sharp knives are inaccessible and stored in a locked safe in the kitchen. The first aid kit is located in the kitchen and contained all required supplies. The facility's smoke detectors and carbon monoxide detectors in each bedroom were checked and were operable. There are no guns or weapons in the facility as stated by House lead Otilli Abuka. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Visitation Policies, and Current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Four Client and four staff files were reviewed during the inspection and noted to have documents required per regulation in the file. All staff work at the facility have department of Justice, FBI and Child Abuse Index clearances. Based on the facility inspection and file reviews this date, are no deficiencies found at this time. A copy of this report was reviewed and given to Administrator Levy Middlebrooks.

report_type: Facility Evaluation

visit_type: Annual

met_with: Levy Middlebrooks


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On July 29, 2022 at 9: AM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. The purpose of the inspection is to conduct a required annual inspection. The facility is a single-family home, with four client bedrooms, two bathrooms, dining room, living room, kitchen, family room, laundry room, staff office and garage. Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C1). Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C2). Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C3) Bedroom# 4 the room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C4). Bedrooms are arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There is sufficient linens, blankets, towels and pillows.The smoke detectors and carbon monoxide detectors were checked and were working properly. The office is maintained locked and staff/client files are kept on site. All hazardous items have been properly stored and made inaccessible. The medications are locked in a kitchen cabinet. There is a lockbox for refrigerated medications available. The garage is maintained locked and consists of an extra refrigerator, washer/dryer, cleansers/chemicals locked in cabinet and extra PPE locked in a cabinet. Sharp knives were inaccessible and stored in the locked in a safe in kitchen cabinet. First Aid kit was accessible and had all required items including the thermometer. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 115 degrees and maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. (see continuation form LIC 809-C dated 07/29/22) All required postings were visible: Personal Rights, The Facility Sketch, Emergency Disaster Plan and visitation policy were posted. LPA inspected the physical plant, operational requirements, disaster preparedness, emergency intervention plan and reviewed four of four client files (C1-C4) (see confidential name list, LIC811, dated 07/29/2022) and began six of six staff files (S1-S6). Due to time constraints, the annual inspection is being extended for completion of staff file reviews, staff interviews and client interviews. Based on record review, the licensee did not comply as four staff (S3-S6) out of six staff [S1-S6] the facility did not ensure that personnel records are maintained on each employee; four out of four client (C1-C4) files did not have the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication; and four out of four clients (C1-C4) did not have a copy of the child's original needs and services plan signed by the child and his/her authorized representative(s), that they were offered the opportunity to participate in plan development; and verification that the authorized representative(s) have approved the plan which poses a potential health, safety or personal rights risk to persons in care. The facility is being issued a citation in accordance with the Title 22, CCR 80066(a); CCR 84070(b)(12) and CCR84070(c)(1). See LIC809-D dated 07/29/22 for the cited deficiency. An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information

met_with: Otilli Abuka/ Levy Middlebrooks


summary: Facility Evaluation

raw_content:
Narrative:
On August 05, 2022 at 2: PM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. The purpose of the inspection is a continuation of the required annual inspection. LPA completed the inspection of six of six staff files (S1-S6) (see confidential name list, LIC811, dated 08/05/2022) three of three staff interviews (S1, S4, S7) and clients (C1-C4) were unable to be interviewed due to clients being non-verbal. During the inspection and file review, no further deficiencies were observed. An exit interview was conducted, and this report was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On August 05, 2022 at 1: PM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. LPA cleared the plan of correction due on 08/05/2022 by conducting a facility inspection of records: LPA reviewed client files (C1-C4) to ensure a copy of the written authorization of the child's parent or guardian, for each psychotropic medication for clients (C1-C4) was maintained in each client file(C1-C4). LPA reviewed clients(C1-C4) needs and service plan and verified signatures documented & attempts to reach social worker for signature were documented. LPA reviewed 4 staff files (S1-S4) and ensured that each personnel records were complete. An exit interview was conducted, and this report was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On July 27, 2023, at 9: AM Licensing Program Analysts (LPA's) Lucero Jauregui and Jacob Salem conducted an announced annual facility inspection. LPA's met with Otili Abuka, Facility Manager who provided LPA's with a guided tour of the facility both indoors and outdoors. The facility is a four bedroom and two bathroom (for client use) in a one story home. The facility consists of a staff office, bedrooms, living/dining room, kitchen, and a two car garage that is being used as a laundry room and for storage. All bedrooms serve one client each. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hygiene closet is located in bathroom 2. Additional linens, bedsheets, and towels were located in the hallway closet. The kitchen was clean and free from observable hazards. Sharps are maintain in a safe behind a locked cabinet, and detergents are locked under the kitchen sink. LPA's observed supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Medication is centrally stored in the locked kitchen cabinet. A first-aid kit was observed in the kitchen cabinet with all required items. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathroom and is currently 111.0 degrees which is in ration. Per facility staff, no firearms or weapons are allowed in the facility. LPA's observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Meal Menu, Staff Schedule and Emergency Plan. Continued... Facility vehicle was inspected by LPA's and no deficiencies were observed. Four out of four client files were reviewed (see confidential name list, dated 7/27/23) and four staff files were reviewed. LPA's conducted two staff interviews. LPA's were unable to interview four out of four clients due to them being non-verbal. Based on observations made during the inspection, no deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided to Otili Abuka, Facility Manager.

met_with: Otili Abuka, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2024, at 11: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced annual facility inspection. LPA Jauregui met with Otili Abuka, Administrator who provided LPA with a guided tour of the facility both indoors and outdoors. The facility is a four bedroom and two bathroom (for client use) in a one story home. The facility consists of a staff office, bedrooms, living/dining room, kitchen, and a two car garage that is being used as a laundry room and for storage. All bedrooms serve one client each. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hygiene closet is located in bathroom 2. Additional linens, bedsheets, and towels were located in the hallway closet. The kitchen was clean and free from observable hazards. Sharps are maintain in a safe behind a locked cabinet, and detergents are locked under the kitchen sink. LPA observed medication centrally stored in the locked kitchen cabinet. A first-aid kit was observed in the kitchen cabinet with all required items. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathroom and is currently 112.7 degrees which is in ration. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Meal Menu, Staff Schedule and Emergency Plan. Continued... Four out of four client files were reviewed (see confidential name list, dated 7/23/24) and five staff files were reviewed. LPA conducted two staff interviews. LPA was unable to interview four out of four clients due to them being non-verbal. Based on observations made during the inspection, no deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided to Otili Abuka, Administrator.

met_with: Otili Abuka, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst's (LPA's) Jose Gonzalez and Joon Choi on April 16,2025 at approximately 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA's Gonzalez and Choi met Administrator Otilli Abuka and conducted a tour of the facility. During the visit there were three staff present and three client's at the facility. LPAs reviewed one client record and two of staff personnel files on site at the facility. LPAs reviewed one client psychotropic medications and medication records. LPAs interviewed two staff on site to discuss the facilities policies and procedures of operation. LPAs attempted to interview one child on site that is currently prescribed psychotropic medication. (See LIC 812) During the inspection the LPAs observed no deficiencies. LPAs provided a copy of this licensing report to Administrator Otilli Abuka.

met_with: Administrator Otilli Abuka


facility_name: PEOPLE'S CARE FREMONT PEAK

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80076(a)(1) and Section 80076(a)(17). See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of the report was left with Interim Administrator Kourtney Hamilton, whose signature on this form confirms receipt.

Investigation Findings:
13On Wednesday 5/11/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to open a complaint investigation of the above allegations. LPA met with Interim Administrator Kourtney Hamilton and Training Administrator Rizza Madlangbayan and informed of the purpose of the visit. Safety percautions were taken, including mask-wearing and pre-visit screening call. During visit, LPA inspected the faciilty kitchen and observed a jar of ThickenUp drink thickener that expired in January 2021 and an old and mushy zucchini in the refrigerator. LPA also observed multiple packages of meat in the freezer with no date of when placed in the freezer, which is significant due to there being a torn package of meat and a bent hamburger patty that may not have been properly stored prior to freezing. There was a leaking package of hot dogs in the refrigerator, and the liquid had leaked significantly into the drawer so that LPA's hand was dripping when picking up an item in the drawer. LPA observed an open container of yogurt in the back of the refrigerator and a plastic piece of trash in a drawer that was disposed of by staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: VISIT DATE: 05/11/2022

met_with: Interim Administrator Kourtney Hamilton, Training Administrator Rizza Madlangbayan

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
... capable of administering the medication. However, the nursing hours had not yet been cut. Per interviews, due to anticipating the hours would be cut, despite the hours still being in effect, no additional nurse staff was hired or sought. The resident at the sister facility was not being switched to the nasal medication due to the physician determining that this resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, LPA nor Interim Administrator were able to locate documentation of the nursing hours currently in effect, and the care plans do not clearly state the specifics of the nursing hours that were in effect. As such, this aspect of the care and treatment services to be provided to both residents cannot be verified, and it cannot be confirmed that the facility is following the care plans as agreed upon by the care teams. Additionally, based on interviews, it was known to the facility that the nursing hours were still in effect for the resident formerly in placement at this facility and that this was still an agreed upon service to be provided to this resident. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84069.2. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt.

Investigation Findings:
13On 8/4/22 at 11:29AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver findings for an investigation of the above allegation. LPA met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit. Based on record review and confidential interviews, the facility had a resident in care (Refer to LIC 811, dated 8/4/22) with specialized in-home health care needs who had approved 1:1 nursing hours to administer a rectal medication for seizures. The licensee has a nearby sister facility, at which there is a resident who also has specialized in-home health care needs and who also has approved 1:1 nursing hours to administer a rectal medication for seizures. On at least two occasions, the Interim Administrator of the facility, who no longer works for the agency, asked the former resident's nurse to leave the facility to go to the sister facility to tend to the resident at the sister facility. Based on confidential interviews, the former resident was being switched to a nasal seizure medication for which the care team determined nursing hours would not be required. This resident's file contained documentation signed by the physician verifying that the facility staff were... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-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, TRAEGER AVE., Suite San Bruno, CA Facility Name: People's Care Fremont Peakfacility Number: Visit Date: 08/04/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32... capable of administering the medication. However, the nursing hours had not yet been cut. Per interviews, due to anticipating the hours would be cut, despite the hours still being in effect, no additional nurse staff was hired or sought. The resident at the sister facility was not being switched to the nasal medication due to the physician determining that this resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, LPA nor Interim Administrator were able to locate documentation of the nursing hours currently in effect, and the care plans do not clearly state the specifics of the nursing hours that were in effect. As such, this aspect of the care and treatment services to be provided to both residents cannot be verified, and it cannot be confirmed that the facility is following the care plans as agreed upon by the care teams. Additionally, based on interviews, it was known to the facility that the nursing hours were still in effect for the resident formerly in placement at this facility and that this was still an agreed upon service to be provided to this resident. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84069.2. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt. SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-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, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: 075650140

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


raw_content:
Narrative:
... of Monday 10am-2pm, Wednesday 10am-2pm, Thursday 6am-2pm and 2pm-10pm. The preponderance of evidence standard has been met, and therefore the above allegation(s) is/are found to be substantiated. LPA is issuing a citation of Title 22, Section Plan of Operation. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Houselead Tajanae Jacobs, whose signature on this form confirms receipt. ...hours working on site or with the residents directly each week to keep the facility in compliance. The current interim administrator has recently completed the administrator examination and is awaiting the administrator certificate. Lastly, on 8/4/22, during LPA's visit to the facility, LPA obtained copies of the staff screening log, which reflected no screenings were logged on multiple days in June, July, and August, and only one screening was logged on multiple days in these months. Per the LIC 500 obtained, multiple staff work shifts each day, so there should be more than one screening logged each day. However, staff wear masks, staff observed and interviewed did not show symptoms of COVID-19, the facility has limited in-person activities and visits, has signs posted on symptoms and health guidelines, and has maintained the facility in sanitary condition. Staff conducted LPA's entry screening today without prompting. Daily screenings are strongly advised, per Provider Information Notices (PINs) issued during the pandemic, to be completed and LPA advises logging screenings for verification. Although the allegation(s) may have happened or is/are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation(s) is/are unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Houselead Tajanae Jacobs, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Houselead Tajanae Jacobs


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
... including during an incident in which a resident ran toward another resident and hit them. LPA observed the resident who was hit to cower near the other resident. LPA also witnessed the resident with aggressive behavior was irritated and had been told by staff that they would take the resident on a van ride. However, staff did not keep this promise. If staffing was the issue, then this was not an appropriate redirection, as it could not be fulfilled. Further, based on interviews and record review, this resident is physically aggressive with other residents and has hit residents before. The facility has a restraint plan in place but prefers to use verbal de-escalation. Based on interviews, though, there have been multiple occasions where the de-escalation plan could not be followed because there were not enough staff for a restraint. On multiple occasions, the resident who was hit has not been taken to school due to insufficient staffing to prevent the other resident from hitting them, for which a citation was issued on 10/12/22. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personal Rights and Section Responsibility for Providing Care and Supervision. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

Deficiencies:
52243: People's Care Fremont Peakfacility Number: 075650140 Visit Date: 12/22/2022 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...  including during an incident in which a resident ran toward another resident and hit them.  LPA observed the resident who was hit to cower near the other resident.

LPA also witnessed the resident with aggressive behavior was irritated and had been told by staff that they would take the resident on a van ride.  However, staff did not keep this promise.  If staffing was the issue, then this was not an appropriate redirection, as it could not be fulfilled.  Further, based on interviews and record review, this resident is physically aggressive with other residents and has hit residents before.

title:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., Suite 360 San Bruno, CA 94066 Facility Name


raw_content:
Narrative:
However, this is why calling 911 immediately to seek timely medical attention is important. The facility has a history of admitting residents with seizures, so all staff should be trained on seizures. It was also learned that this resident had a seizure in 2019 which was not reported to the licensing agency or to the authorized representative. During a file review conducted today, LPA observed that there was no incident report for this in the file, despite the file containing reports from 2019. Additionally, based on observation and interview, staff were not aware of the activity calendar and confirmed it had not been implemented, including not doing holiday crafts on a holiday as written on the calendar due to there being no crafts provided and not knowing crafts to be planned. LPA observed in the month of December that the activity plan for October was still posted, and staff were unfamiliar with the November plan. Training on facility activities is required, as the activities being planned is meant to ensure residents are able to engage in enjoyable and skill-building activities, which will also enable staff to monitor resident behaviors and assess whether residents are meeting behavior goals laid out in the needs and services (behavior) plans. Further, during today's visit, LPA observed that the behavior tracker for a resident for whom the behavior plan requires staff to track behaviors had 9 missing full days and an additional 22 missing shifts. Lastly, on 8/4/22, a few days prior to receipt of the complaint, alleging resident records were not maintained at the facility, LPA observed the needs and services plans to not be updated and/or current plans not maintained in the file. A citation was issued. During today's visit, LPA inspected residents records and observed that all four files were missing the current needs and services (behavior report) plans prepared on a quarterly basis by the behaviorist, supplied to LPA by behaviorist and dated October to November 2022. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing 6 citations of California Code of Regulations, Title 22, Section Personal Rights, Section Personnel Requirements, Section Reporting Requirements, Section Planned Activities, and Section Client Records. An exit interview was conducted, appeal rights provided, and a copy of this report left with Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

Deficiencies:
84070: (5) Copies of any modifications to the child's needs and services plan...signed by...his/her authorized representative(s)

title:
Children's Records
(c)...the following additional information shall be maintained in the child's record


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Interim Administrator Kylie Leblanc


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a follow-up complaint visit. LPA met with Compliance & Training Specialist Erinique Jones and Interim Administrator Kylie Leblanc and informed of the purpose of the visit. During visit, LPA inspected resident mattresses and observed one to have a dip in the middle and one to have multiple tears exposing the foam. Staff informed LPA that new mattresses have been purchased, including one which has already arrived. Staff opened the package and laid out the mattress to expand to be placed in the room with the torn mattress. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84088. An exit interview was conducted, appeal rigths provided, and a copy of this report was provided to Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-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, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: 075650140


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Narrative:
Additionally, based on confidential interview, observation, and record review, two residents' hygiene needs were not being met, resulting in hair being uncared for, messy, and/or long and nails being untrimmed, which were partially due to resident behaviors. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of California Code of Regulations, Title 22, Section 84065.2 and Section 80078. See attached LIC 9099-D pages. An exit interview was conducted, appeal rights provided, and copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt. ... medication during an escalated incident due to not being able to access the locked medication room. However, based on confidential interview, observation, and record review, it could not be determined that the resident should have been administered medication nor that the resident was prescribed an emergency PRN medication for behavior. Lastly, it was reported that resident beds had improper bedding. Based on confidential interview, observation, and record review, the beds were fitted with clean bedding that met applicable licensing requirements but did not align with internal procedures not specifically outlined in the plan of operation. The facility has since updated all bedding to meet the additional elements of the internal procedures. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

Deficiencies:
43542: People's Care Fremont Peakfacility Number: 075650140 Visit Date: 05/26/2023 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32... medication during an escalated incident due to not being able to access the locked medication room.  However, based on confidential interview, observation, and record review, it could not be determined that the resident should have been administered medication nor that the resident was prescribed an emergency PRN medication for behavior.

Lastly, it was reported that resident beds had improper bedding.  Based on confidential interview, observation, and record review, the beds were fitted with clean bedding that met applicable licensing requirements but did not align with internal procedures not specifically outlined in the plan of operation.

met_with: Administrator Jose Guzman

title:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST SC/RES, 851 TRAEGER AVE., Suite 360 San Bruno, CA 94066 Facility Name


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Although the allegation may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt. Statements did not indicate that the residents' prescribing physicans were consulted that day but did indicate that the issue was addressed with the pharmacy that day. Statements do confirm that medications were not administered as prescribed. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80075. See attached LIC 9099-D page. An exit interview was conducted, appeal rights provided, and copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


raw_content:
Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

met_with: Administrator Timothy Haliburton


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 8/19/21 at 9:55AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Interim Administrator Morgan Ray and informed of the purpose of the visit. There were no staff on duty at the site, other than Administrator, and no residents were present. One resident was on a home visit, one resident was on an outing with two staff, and two residents were in school. LPA used the inspection tool to conduct the facility inspection. LPA reviewed the files for current residents and staff members. All files were complete. Staff training was current and meets requirements. Staff are cleared and have current CPR and CPI certificates. Resident records were complete. Medications are stored properly, and logs are well maintained. The facility is operating according to the license. LPA observed that the facility is not using the PMAR (LIC 622B Psychotropic Medication Administration Record), or variation of the form that includes all information requested on the LIC form, to log psychotropic medications separately. Psychotropic medications are logged separately but not on a separate log. LPA provided the PMAR and advised, per Title 22, Section 84070, that the licensee begin using the log, or variation, by next month. LPA observed that the facility does not have complaint procedures posted in the facility. LPA advised, per Title 22, Section 84072.2, that the licensee begin posting complaint procedures at the facility site so that it is visible to residents and especially authorized representatives. The facility site and grounds were inspected. The facility is clean and sanitary. There are no obstructions or bodies of water. Per Administrator, there are no firearms or ammunition on the premises. Chemicals and cleaning solutions are kept in a locked storage closet. Medications and resident funds are kept in a locked storage room, with the funds in a locked safe. Sharps are kept in a locked drawer in the kitchen. Food storage is sanitary, and there is food to meet the needs of the residents in care and that meets the 7-day nonperishable, 2-day perishable mandate. Food is fresh and not expired. Hot water and room temperatures measured within permitted ranges, at 111. F and F, respectively. There are no citations. Two advisories were provided at visit. An exit interview was conducted with Interim Administrator Morgan Ray, whose signature on this form confirms receipt.

met_with: Interim Administrator Morgan Ray


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 4/13/22 at 12:15PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding multiple incident reports of staff possibly showing aggressive behaviors toward residents in care. LPA met with Assistant Administrator Angela Hague and informed of the purpose of the visit. Safety precautions were taken, including entry screening, mask-wearing, and pre-visit screening call. During visit, LPA interviewed Asst. Administrator and two present care staff. LPA collected relevant resident and staff information and documentation, authorized representative contact information, and reviewed staff files. LPA requested the following: most current Individualized Program Plan (IPPs) or similar treatment plan for all residents in care; most current CPI certificates for all staff. Residents are nonverbal and were observed at visit to be content and well supervised. Further investigation is needed at this time. An exit interview was conducted, and a copy of this report was left with Asst. Administrator Angela Hague, whose signature on this form confirms receipt.

met_with: Assistant Administrator Angela Hague


summary: Facility Evaluation

raw_content:
Narrative:
On 8/19/22 at 12:00PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection at the facility. LPA met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit. The CARE Inspection Tool was used to conduct this inspection. The facility is clean, and kitchen and bathroom spaces are sanitary. Outdoor activity space is free of hazards, and all emergency exits are unobstructed. First aid kit was observed to be complete. The facility is maintained at a comfortable temperature within permitted range. Hot water was below range. See below. Kitchen was stocked with quality food within date and in enough quantity to meet the needs of residents in care. Medication records are complete and match prescriptions and medication counts. License, residents' personal rights, and an emergency and disaster plan are posted in the facility. During inspection, LPA observed that hot water measured 103. F at all sinks (both bathrooms and the kitchen), below the lower end of the permitted range of F. LPA reviewed the hot water daily log going back to June and observed that hot water fluctuates to within and just below required range. LPA is issuing an advisory per California Code of Regulations, Title 22, Section Furniture, Fixtures, Equipment, and Supplies. See LIC 9102. A continuation visit will be conducted to complete the review of personnel records. No additional deficiencies were found and no citations are being issued today. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 9/14/22 at 10:38AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual continuation inspection. LPA met with Staff Linda McCormick and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct this inspection. One staff interview and one resident interview was conducted at the initial inspection, and two staff interviews were conducted at today's inspection. LPA observed nonverbal residents to be engaged in activity and with staff, dressed in clean, well-fitting clothes, and to appear happy and content, comfortable with staff, and smiling and waving in greeting LPA. The physical plant and resident records were inspected at the initial visit, and personnel and facility records were inspected at today's visit. The facility was clean and sanitary, and LPA did not see any physical plant violations requiring further inspection. LPA observed files to be complete with some exceptions listed below. See attached LIC 809-D pages. 1) LPA observed that staff S2 (Refer to LIC Confidential Names, dated 9/14/22) does not have a file available for review. LPA is issuing a citation of California Code of Regulations (CCR), Title 22, Section Personnel Records. 2) Staff JS does not have a clearance associated to the facility and has been working for two weeks. LPA is issuing a citation of CCR, Title 22, Section Criminal Record Clearance. Additionally, per 80019(g), LPA is assessing an immediate civil penalty of $500. See LIC 421BG. 3) Personnel records do not reflect that 20 hours of annual training were completed in the last 12 months for staff hired over 12 months ago or 40 hours (initial training combined with 16 hours of annual training) for staff hired within the last 12 months. LPA is issuing a citation of CCR, Title 22, Section Personnel Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report was left with the facility. Linda McCormick's signature confirms receipt.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information

met_with: Interim Administrator Rizza Madlangbayan


summary: Facility Evaluation

raw_content:
Narrative:
On 7/21/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Interim Administrator Timothy Haliburton. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA observed the facility to be clean and organized. Facility, staff, and resident records were observed to be complete and organized. Resident files contain current plans which are filed properly and where accessible to staff. Shift notes are organized and separated by resident. Staff files are organized, and training records are detailed and complete. Residents are currently attending schools or day programs or are on summer break. The facility is in the process of designating an administrator who will not oversee another facility simultaneously. Residents who are over the licensed age range have granted age exceptions, and the facility is in the process of transitioning to a new facility type to continue to meet the needs of residents aging out of the children's program. LPA observed the facility to be operating in compliance with the NCC terms. No deficiency citations were issued at today's visit. An exit interview was conducted, and a copy of this report was left with Interim Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/14/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Interim Administrator Timothy Haliburton and informed of the purpose of the visit. LPA notes that documents were submitted for Interim Administrator's approval last week, and LPA's review is in progress. LPA used the CARE Inspection Tool to complete this inspection. LPA toured the facility site, reviewed facility records, and conducted one staff interview. LPA obtained a staff contact sheet. LPA observed the facility to be clean and sanitary, facility records and logs were organized and well-maintained, and supply of linens, food, and other supplies were large enough to meet the needs of the residents in care. LPA did not observe any hazards in the activity spaces inside or outside. There were no citations during today's visit. An exit interview was conducted, and a copy of this report was left with Interim Administrator Timothy Haliburton, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Interim Administrator Timothy Haliburton. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA interviewed and observed staff and inspected staff and resident records. LPA observed the records to be complete and well-organized. Medication records are accurate to the medication labels and quantities. Staff records reflect that staff have received training on required topics, including facility procedures, de-escalation/intervention, medication, and resident plans. Staff have valid first aid and intervention (CPI) certifications. LPA observed the facility to be clean and organized and to have fun decorations for the upcoming holiday. LPA observed staff to communicate well with each other, to ensure constant engagement with the residents, and to ensure activity planning is done. The facility has a designated administrator who oversees only one facility. The facility also maintains communication with outside agencies, including Community Care Licensing, Regional Center, and resident schools. LPA observed the facility to be operating in compliance with the NCC terms. No deficiency citations were issued at today's visit, and there are no outstanding plans of correction (POCs). An exit interview was conducted, and a copy of this report was left with Interim Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/13/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Administrator Timothy Haliburton. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA inspected staff and resident records and went over the last quarter's compliance with Administrator. LPA observed the records to be complete and well-organized. Staff records reflect that staff have received training on required topics, including facility procedures, de-escalation/intervention, medication, and resident plans. Staff have valid first aid and intervention (CPI) certifications. LPA observed the facility to be clean and organized and to have fun decorations for the upcoming holiday season. Chemicals and medications were stored in locked closets where inaccessible to residents. LPA observed staff to communicate well with each other and to ensure developmentally appropriate engagement with the residents. The facility has a designated administrator who oversees only one facility. Administrator confirmed that the application to transition the facility into an adult residential facility (ARF) is pending. Administrator has completed the ARF administrator training and examination and is awaiting the certificate. LPA observed the facility to be operating in compliance with the NCC terms. No deficiency citations were issued at today's visit, and there are no outstanding plans of correction (POCs). An exit interview was conducted, and a copy of this report was left with Administrator Timothy Haliburton, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/21/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a quarterly case management visit per the agreed upon terms of the noncompliance conference (NCC) held in March 2023. LPA met with Administrator Timothy Haliburton and informed of the purpose of the visit. Per the other terms of the NCC, the facility is to maintain an administrator who oversees only this facility and is on site 5 days a week and for at least 20 hours a week, designate at least 1 facility manager for each shift, ensure required staff to resident ratios are met, ensure all residents attend a school or day program, and ensure staff training hours are met and records well maintained. The facility has one qualified administrator who oversees only this facility and who is on site 5 days a week and at least 20 hours a week. There are more than 4 designated facility managers. All staff records reviewed reflected staff have background clearances, complete onboarding/initial training, and have met annual training hours with training that covers required topics. Records were well maintained and organized. Resident records were similarly well maintained and organized, and care plans are current. All residents are enrolled or in the process of being enrolled in suitable school or a day programs. LPA observed the facility to be clean and tidy. LPA observed staff to communicate well with each other and to demonstrate competence in their job duties, including communicating with residents, maintaining supervision, and understanding the needs and preferences of residents in care. The facility is currently in the process of applying to become an adult residential facility. The application has been submitted. No deficiencies were observed. An exit interview was conducted, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/17/2024, at 10: AM Licensing Program Analysts (LPAs) Mona Lam and Selena Hood visited the above facility. The purpose of the visit is to conduct a quarterly non-compliance inspection of the facility. LPAs met with Administrator, Timothy Haliburton, that assisted with the inspection. Upon arrival, no clients and staffs were in the facility. During the inspection, two staffs enter the facility with two clients. Clients are non-verbal. Per the other terms of the NCC, the facility is to maintain an administrator who oversees only this facility and is on site 5 days a week and for at least 20 hours a week, designate at least 1 facility manager for each shift, ensure required staff to resident ratios are met, ensure all residents attend a school or day program, and ensure staff training hours are met and records well maintained. During the inspection, LPAs observed facility to be clean and organized. The facility has a designated administrator who oversees only one facility. Facility, staff, and resident records were observed and were organized and complete. Clients who are over the licensed age range have granted age exceptions. Training records are detailed. Two clients are not in school, but facility showed documentation that they are attempting to get residents enrolled. One resident is attending a day program. The facility is currently planning on transitioning to an adult home, and the application has been submitted. LPAs conducted four staff interviews. Based on observation of record review, interviews, and staff schedule, the facility's schedule represents 2:3 staff to client ratio. However, the facility Program Statement states that the facility will utilize a 1:1 staff and client ratio. LPAs delivered a technical violation for 80022(k) Plan of Operation, the facility should ensure that the Program Statement and program procedures are consistent. An exit interview was conducted with Administrator 2: PM. A printed copy of the report with an appeals rights page were discussed and left with the Administrator.

met_with: Adminstrator, Timothy Haliburton


summary: Facility Evaluation

raw_content:
Narrative:
On 8-22-24 10:45AM, Licensing Program Analyst George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Tim Haliburton, Administrator and toured the facility inside and out. The Group Home is licensed to serve 4 clients. Present during the inspection were two staff and one client. At 11:00AM LPA Karkazis reviewed client and staff files. All staff and client files were complete and in good order. At 12:55PM, LPA Karkazis toured the facility. LPA Karkazis observed 4 bedrooms and 2 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 107 degrees which is in range. The thermostat read 70 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a closet. The facility is in good repair and clean. LPA Karkazis interviewed two staff and the one client refused the interview. The other two clients were at school and non verbal. At 1:23PM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Tim Haliburton, Administrator.

met_with: Tim Haliburton, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 1/22/25, Licensing Program Analyst (LPA) Jonathan Medina conducted a quarterly case management visit per the agreed upon terms of the noncompliance conference (NCC) held in March 2023. LPA met with Administrator Timothy Haliburton and informed of the purpose of the visit. Upon arrival, three clients and three staffs were in the facility. Per the other terms of the NCC, the facility is to maintain an administrator who oversees only this facility and is on site 5 days a week and for at least 20 hours a week, designate at least 1 facility manager for each shift, ensure required staff to resident ratios are met, ensure all residents attend a school or day program, and ensure staff training hours are met and records well maintained. The facility has one qualified administrator who oversees only this facility and who is on site 5 days a week and at least 20 hours a week. There are more than 4 designated facility managers. All staff records reviewed reflected staff have background clearances, complete onboarding/initial training, and have met annual training hours with training that covers required topics. Records were well maintained and organized. Resident records were similarly well maintained and organized, and care plans are current. All residents are enrolled or in the process of being enrolled in suitable school or a day programs. LPA observed the facility to be clean and tidy. During meeting one of the clients seemed to be agitated from LPAs presence and was taken on a walk by one of the facility managers. Clients were not interviewed since they are non-verbal. Administrator and other Facility Manager were interviewed. The facility is in the process of applying to become an Adult Residential Facility (ARF). The application has already been submitted. LPA spoke with Robert Subia over the phone, who confirmed that the facility has been actively working toward becoming an ARF and has a scheduled date for a walk through to obtain licensure soon. Two clients are already 22 and one is 18. No deficiencies were observed. An exit interview was conducted, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.

met_with: Timothy Haliburton - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 2/16/22 at 11:10AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility and met with Assistant Administrator Angela Hague. LPA informed of the purpose of the visit. Safety precautions were taken including screening call, screening upon entry, and mask wearing. During visit, LPA toured the facility site and grounds and observed 8 cigarette butts in the front yard. LPA took photos and showed the locations to Angela. LPA and Angela searched the rest of the facility grounds and did not observe any more elsewhere. LPA issued a citation of California Code of Regulations, Title 22, Section Buildings and Grounds. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Assistant Administrator Angela Hague, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On Wednesday 4/13/22 at 11:47AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility, during which two deficiencies were observed. LPA met with Assistant Administrator Angela Hague and informed of the purpose of the visit. Safety precautions were taken, including entry screening, mask-wearing, and pre-visit screening call. Upon entry to the facility, LPA Hawkins observed two cigarette butts on facility grounds in the side yard next to the bushes that separate the facility site from the neighboring property and next to the facility van. LPA took photos of observed cigarette butts. Upon meeting with Asst. Administrator, who arrived approximately 20 minutes after LPA's arrival, LPA inspected the grounds with Asst. Administrator, who observed the two cigarette butts LPA observed and noticed a third cigarette butt that LPA had not observed. Asst. Administrator immediately removed all cigarette butts. Cigarette butts were observed at a previous visit on 2/16/22, and a citation was issued on that day. LPA is issuing a citation of California Code of Regulations, Title 22, Section Buildings and Grounds as well as an immediate civil penalty for repeat violation of $250. See attached LIC 809-D and LIC 421. Additionally, upon entry to the facility, LPA observed that there were two staff working and two residents present. Assistant Administrator stated that neither staff is a facility manager nor has a designation of facility responsibility. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Asst. Administrator Angela Hague, whose signature on this form confirms receipt.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 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

met_with: Interim Administrator Angela Hague


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 5/11/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for an investigation. LPA met with Interim Administrator Kourtney Hamilton and Training Administrator Rizza Madlangbayan and informed of the purpose of the visit. As LPA walked up to begin the first visit at the facility, at 10:03AM, LPA observed two cigarette butts in the front area of the facility grounds. One was in the side yard by the side bushes, and one was on the driveway. During visit, LPA toured the facility grounds with Interim Administrator and Training Administrator. During the search, two more cigarette butts were found, for a total of four cigarette butts. Interim Administrator stated a search was done at the facility the previous evening, so these must have been between then and 10AM. All cigarette butts were removed immediately. Cigarette butts were observed at previous visits on 2/16/22 and 4/13/22, and citations were issued. LPA is issuing a citation of California Code of Regulations, Title 22, Section Buildings and Grounds as well as an immediate civil penalty for repeat violation of $250. See attached LIC 809-D and LIC 421. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Kourtney Hamilton, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/4/22 at 2:30PM, Licensing Program Analyst (LPA) Mariah Hawkins delivered notice of deficiencies found during an inspection at the facility. LPA met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit. During an investigation at the facility, LPA conducted a record review and observed that the needs and services for a resident (see LIC 811) were not being updated every 6 months, and current plans were not maintained in the resident's file. On 8/4/22, LPA observed that the needs and services plan dated 11/21/20 in the file is blank and directs reader to refer to the Individualized Program Plan (IPP). LPA located the Regional Center of the East Bay IPP, dated 1/2/20, and Interim Administrator stated this is the most current record. However, the previous Interim Administrator provided LPA with two plans, one a behavior report dated 2/1/22 and signed by the behaviorists and one an Individualized Service Plan (ISP) dated 1/12/22 and signed by only the previous Interim Administrator. The file did not contain, and thus, does not reflect that care plans are being updated every 6 months. LPA is issuing citations of California Code of Regulations (CCR), Title 22, Section 84068.3(a) and Section 84070(c). See attached LIC 809-Ds. Additionally, during visit LPA reviewed the medication records for the same resident and observed that psychotropic medications are not being documented on a separate log, including clonidine, divaloroex sodium, clobazam, lamotrigine, lorazepam (PRN), and sertraline. LPA previously advised the facility of this requirement on 8/19/21 and provided the correct form to use on 8/20/21. The current log also does not contain the prescription date nor the number of refills. LPA is issuing a citation of CCR, Title 22, Section 84070(b). See attached LIC 809-Ds. Lastly, a nursing assessment in the same resident's file, dated 2/10/22, indicated that the resident is bedridden, but the physician's report and capability assessment indicate the resident is nonambulatory. Interim Administrator stated that this resident is not bedridden and can transport self to a chair. Records also show resident can walk with assistance. LPA advises, per CCR, Title 22, Section 80010, that the facility must operate in accordance with their license, which permits ambulatory and up to two nonambulatory residents but bedridden residents are not permitted. See attached LIC 9102. An exit interview was conducted, appeal rights provided, and a copy of this form was provided to Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt.


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 10/12/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility, during which the below deficiencies were observed. LPA met with Care Staff Linda McCormick and informed of the purpose of the visit. During visit, LPA observed that there was one staff present and three residents present. One staff was on a van drive with one resident. The facility was not within ratio, which per the program statement is one staff to two residents (1:2). The facility was previously cited for this on 09/30/22. LPA is issuing another citation of California Code of Regulations (CCR), Title 22, Section Plan of Operation as well as assessing a civil penalty of $250 for repeat violation within 12 months. Further, neither staff is a facility manager, and the administrator was not on site. The facility was previously cited for no facility manager coverage during administrator absence on 04/13/22. LPA is issuing another citation of CCR, Title 22, Section Personnel Requirements as well as assessing a civil penalty of $250 for repeat violation within 12 months. Additionally, when LPA requested the activity calendar, staff informed LPA that there was no current activity calendar and no planned activities. One resident was not taken to school due to another resident having a behavior and staff feeling it would not be an efficient use of time to transport the resident since they would get out of school soon. LPA is issuing a citation of California CCR, Title 22, Section Planned Activities. Lastly, at least one resident has aged out of the children's residential age range. The facility is licensed for up to age 17, and an age exception can be granted up until the age of 22. Of the four residents, two are 20 or older and 2 are under 18. The facility was previously advised of the requirement to ensure an age-appropriate placement for this resident and informed LPA that the delay was on the placing agency's end. LPA is issuing a citation of CCR, Title 22, Section Limitations on Capacity and Ambulatory Status. An exit interview was conducted over the phone with District Manager Kourtney Hamilton and appeal rights and a copy of this report was emailed to District Manager Kourtney Hamilton, who agreed to sign and return to LPA as confirmation of receipt.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 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
84079: (4) Educational activities, including attendance at an educational program...

met_with: Care Staff Linda McCormick; District Manager Kourtney Hamilton

title:
Planned Activities
(a) The licensee shall develop, maintain, and implement a written plan to ensure that indoor and outdoor activities which include...


summary: Facility Evaluation

raw_content:
Narrative:
On 12/7/22 at 10:39AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a health check regarding a concern that was brought to the Licensing agency. LPA met with Direct Support Staff Linda McCormick and informed of the purpose of the visit. LPA also met with Facility Managers Tajanae Jacobs and Timothy Haliburton. LPA toured the facility site and interviewed two staff and one resident. LPA did not observe piles of laundry or any odor in the facility. However, one resident has no fitted sheet or mattress pad, and two residents have only fitted sheets with no comforter. Additionally, one resident has no clean underwear and is in diapers. The washing machine has been broken for two weeks, and laundry was picked up yesterday by staff at a sister facility under the licensee to be washed at that location. The issue was communicated with management, but the solution has not been timely, resulting in the above lack of sheets and clothing items. LPA is issuing a citation of California Code of Regulations, Section Personal Rights. An exit interview was conducted, appeal rights provided, and a copy of this report provided to the facility. Facility Manager Timothy Haliburton's signature on this form confirms receipt.

met_with: Facility Manager Tajanae Jacobs, Direct Support Staff Linda McCormick; Facility Manager Timothy Haliburton


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12/7/22 at 2PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility to deliver notice of deficiencies observed on this day. LPA met with Facility Manager Tajanae Jacobs and and Facility Manager Timothy Haliburton and informed of the purpose of the visit. During visit, LPA observed that there was only one staff on shift while three residents were in care. Additionally, staff statements confirm that on prior occasions staff have worked as the only staff with three or four residents present. Per the plan of operation, the facility is to maintain a ratio of one staff to two residents. LPA is issuing a citation of California Code of Regulations, Title 22, Section Plan of Operation. A citation was previously issued on 10/12/22 and a plan of correction submitted, but due to the repeat violation, LPA is assessing a civil penalty of $250. LPA also observed that there was no facility manager on shift when LPA arrived. There were three residents present, but the staff on shift was not the administrator, interim administrator, or facility manager. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. A citation was previously issued on 10/12/22 and a plan of correction submitted, but due to the repeat violation, LPA is assessing a civil penalty of $250. An exit interview was conducted, appeal rights provided, and a copy of this report provided to the facility. Facility Manager Timothy Haliburton's signature on this form confirms receipt.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 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

met_with: Facility Manager Tajanae Jacobs; Facility Manager Timothy Haliburton


summary: Facility Evaluation

raw_content:
Narrative:
On 12/22/22, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit. LPA met with Compliance & Training Specialist Erinique Jones and informed of the purpose of the visit. The current interim administrator has not submitted documentation to verify their qualifications. In order to be qualified, an administrator must submit evidence of administrator certification. LPA requested the documents, providing a list of required documents, on 09/28/22, received an incomplete packet on 10/24/22, provided notice of missing items on 11/08/22, received confirmation on 11/17/22 that documents would be resubmitted, followed-up and re-requested re-submission on 12/06/22, received confirmation that documents would be resubmitted by 12/12/22, provided a reminder on 12/19/22, and LPA has not received the packet as of 12/21/22. LPA is issuing a citation of California Code of Regulations, Title 22, Section Administrator Qualifications and Duties. See attached LIC 809-D. Additionally, during a review of resident records, LPA observed that the needs and services plans do not indicate whether residents can handle money, so it is not clear if residents should be provided an allowance. LPA is issuing an advisory of California Code of Regulations, Title 22, Section 84068. Needs and Services Plan. See LIC 9102. An exit interview was conducted, appeal rights provided, and a copy of this report left with Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/9/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Interim Administrator Kylie Leblanc and informed of the purpose of the visit. During visit, LPA observed that from 11:38AM to 12PM, there was only one staff present and three residents present. Per the facility's plan of operation, the facility is to maintain a one staff to two resident ratio at minimum. The facility was previously cited for this on 10/12/22 and 12/07/22. LPA is issuing a citation of California Code of Regulations, Title 22, Section Plan of Operation. LPA is assessing a civil penalty of $250 for repeat violation. Additionally, when a second staff arrived, both staff identified themselves as not being facility managers. However, LPA had been informed that both had been designated and trained as facility managers. When Interim Administrator arrived, she showed LPA evidence of training. However, when LPA reviewed the personnel records, there was no LIC Designation of Facility Responsibility, which had been sent to LPA on 12/8/22, nor any documentation of facility manager training. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Kylie Leblanc, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility for a case management visit. LPA met with Compliance & Training Specialist Erinique Jones and Interim Administrator Kylie Leblanc and informed of the purpose of the visit. LPA received incident reports from a resident's school documenting an observation of bruises that had not been reported to the school or to the authorized representative. As of today, no incident report had been received by the licensing agency of an injury to a resident or of an unusual incident in this month. During visit, LPA requested to review the body check logs, and Interim Administrator stated the documents were not being maintained and none were available for review at visit. LPA discussed the importance of submitting incident reports while the facility is operating, which is 24 hours, 7 days a week, for any injury, even if it happens at school or at home. LPA advised that body check logs be maintained so that staff are in the routine of ensuring they note any injuries they observe, which is especially important for facilities serving nonverbal residents and residents with self-injurious behaviors. LPA is issuing two citations of California Code of Regulations, Title 22, Section Reporting Requirements. See LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
AMENDMENT: Please note that the above listed date of 5/25/23 is incorrect, and the correct visit date is as listed below, 5/26/23. On 5/26/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit. LPA met with Administrator Jose Guzman and informed of the purpose of the visit. During an investigation at the facility, it was learned that, based confidential interviews, record review, and observation, two staff from one of licensee's other facilities who did not have necessary training to provide care and supervision to the residents of this facility were called to cover a night shift. The initial staff member was called by management staff, who was the on-call worker, and who did not answer later calls from the staff when they called for guidance and assistance during an escalated resident incident. The staff were unfamiliar with the facility, the residents, their needs, care plans, specific intervention protocols, and medication procedures, and were unable to access facility records, including medication records, due to not being able to locate the key to the locked storage. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80065. See attached LIC 809-D. Additionally, during the same investigation at the facility, it was learned that one of the above staff members was called in to cover a shift at the facility prior to a background clearance transfer being processed. The staff worked a shift in January 2023, but the application for clearance transfer was not submitted until February 2023. LPA advised the facility to ensure clearances are processed prior to staff working a shift at another facility. LPA also advised the facility of their ability to request a central administrative office waiver to allow clearances to one facility to apply to another named facility licensed by the same licensing office. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt.


facility_name: PEOPLE'S CARE GARTH

raw_content:
Narrative:
Due to lack of evidence and conflicting statements obtained during the investigation, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was emailed to Azeez Lamina, Administrator to sign and return.

Investigation Findings:
13On May 28, 2020 at 11:45 a.m. Licensing Program Analyst (LPA) Cameo Banks conducted a follow-up complaint visit via telephone to People's Care Garth and spoke with Facility Administrator Azeez Lamina. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of investigating the allegations, LPA conducted interviews. The interviews did not produce corroborating evidence to support the allegations. Staff denied allegations. Interviews with Staff revealed that there was a conversation amongst staff and Child #1 assumed they were talking about her and became offended even after staff explained that they were not speaking negatively about her. Child #1 continued to make outbursts insisting that Staff were talking about her. Interviews with Staff also revealed that remaining clients in care are nonverbal therefore denying allegation of talking about Child #1 to other clients. There was no evidence that staff harassed or verbally abused Child #1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Cameo Banks 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: 05/28/2021

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

met_with: Azeez Lamina Administrator


raw_content:
Investigation Findings:
13On December 31, 2021 at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced follow-up complaint inspection at People's Care Garth and met with Quanita Abebide. The purpose of this inspection is to deliver findings on the above complaint allegation. During the investigation process, AGPA Woodard conducted confidential interviews with relevant parties and reviewed supportive documentation. The investigation did not reveal corroborating evidence to support the allegation that facility staff are verbally abusive to clients. Confidential interviews were conducted with five staff who each denied the allegation that they yell and curse at clients. Based on confidential interviews with staff, reporting party, alleged victim, and witnees in addition to the review of supporting documentation, the Department has determined that the personal rights allegation cannot be corroborated. Therefore, the finding is unsubstantiated. An unsubstantiated finding means although the allegation may have happened, the preponderance of evidence does not prove it. A copy of this report was left with staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 2

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

met_with: Quanita Abebide


raw_content:
Investigation Findings:
13On February 2, 2022 at 2:51pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care Garth and spoke with Dajahnae Warmack, Direct Care Staff. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of one (1) client and five (5) staff were interviewed. LPA was unable to conduct confidential interviews with Client #2 (C2) due to C2 is non-verbal. Confidential interviews conducted revealed there was not enough evidence to substantiate facility staff did not provide activities for clients, staff not providing adequate food service to clients, and staff yells at clients. LPA obtained copies of the activity schedule and weekly menu schedule for the clients in care. Based on the interviews conducted, 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. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Administrator. 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 3

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

met_with: Dajahnae Warmack-Direct Care Staff


raw_content:
Narrative:
LPA could not obtain the identity of the alleged perpetrator. Confidential interviews with staff and client confirmed that the staff followed directives accordingly to provide the proper care and treated the alleged victim in placement with dignity and respect, and therefore, did not cause any injury to client. 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:
13On December 8, 2022 at 11:39am, 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 was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. 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". 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: 12/08/2022

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

met_with: Vera Adidi-Administrator


raw_content:
Narrative:
Confidential interviews revealed C1 recanted allegation. LPA observation of Client #1 (C1) during the investigation revealed C1 who stated wanting to go to the hospital. LPA Edison observed C1 to yell and scream that facility staff was trying to choke C1. LPA did not observe any facility staff trying to choke or physically harm C1 in any manner. LPA did not observe any marks, bruises, or injuries on C1. There is no evidence or witnesses to support that "Staff choked minor". LPA obtained additional information from staff who stated that Client #1 (C1) made allegations toward all staff not just Staff #1 (S1). Confidential interviews conducted also reveal staff stated that they could not get in touch with the Administrator when the incident occurred and that they (staff) had just gotten off work earlier that day and did not want to "do a double shift" which is the reason they did not accompany C1 to the hospital. Additional information obtained after the investigation process did not corroborate the allegation. 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 are 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 December 8, 2022 at 12:55pm, 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 was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. LPA made several unsuccessful attempts to conduct confidential interviews with witnesses. 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: 12/08/2022

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