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

Investigation Findings:
13On February 27, 2023 at 10:19am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Tianna Gammage, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. Facility Manager informed LPA that Administrator is out on Administrative Leave on this day. LPA spoke with Administrator by telephone at (562) 540-7724 and discussed the findings. During the investigation, a total of four (4) staff and one (1) client were interviewed. Confidential interviews with staff and Client #1 (C1) did not reveal C1 spends an excessive time in their room and facility staff do not provide C1 with activities. Consistent statements from staff and C1 reveal, C1 has been on outings to the park and to the beach as well as other outings in the residential area of the facility. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 02/27/2023

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

met_with: Tianna Gammage-Facility Manager


state: CA

facility_name: PEOPLE'S CARE GARTH

summary: Complaint Investigation - Unsubstantiated - 1 allegation

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

Investigation Findings:
13This an amended report from the original date of 12/8/2022. On February 27, 2023 at 10:57am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Tianna Gammage, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegation. Facility Manager informed LPA that Administrator is out on Administrative Leave on this day. LPA spoke with Administrator by telephone at (562) 540-7724 and discussed the findings. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. LPA made several unsuccessful attempts to conduct confidential interviews with Staff #2 (S2). Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 02/27/2023

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


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

Investigation Findings:
13On May 5, 2023, at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at the Hargis Adult Residential Home to deliver findings concerning allegations against PEOPLE'S CARE GARTH. LPA Martin met with Facility Representative Dajahnae Warmack, DSP II, to discuss the outcome. LPA Martin also spoke with Facility Administrator, Vera Adidi via telephone. The investigation was referred and conducted by LPA Martin and Community Care Licensing Investigations Bureau. On March 2, 2023, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging personal rights and neglect towards Client #1 (C1) who was reportedly touched inappropriately by a staff member, and that the Facility did not ensure C1 attended school [see Confidential Names form, LIC 811, dated 5/5/2023]. On March 7, 2023, LPA Martin met with Facility Administrator, reviewed client file, and obtained pertinent related information. The investigation further consists of review of facility file, review of associated reports from the Department of Children and Family Services and confidential interviews with related parties including, but not limited to, C1, complainant, and assigned Social Worker. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 05/05/2023

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

met_with: Dajahnae Warmack, DSPII


facility_name: PEOPLE'S CARE KENNETH

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

Investigation Findings:
13On 10/04/2021, at approximately 4: PM, Licensing Program Analyst (LPA) Chad Cabigon conducted an unannounced inspection at this facility to close this complaint investigation and deliver the findings. LPA was met by Ashley Johnson, Direct-Support Professional House Lead, with whom the report was discussed. LPA investigated the allegation, Minor engaging in inappropriate interactions with other minors in care. Prior to this LPA taking over, LPA Ashley King was originally assigned to, and opened, the complaint investigation. On 09/16/2021, LPA Cabigon conducted an unannounced onsite inspection to continue the investigation: LPA conducted interviews with two facility youths and staff; one other child refused to be interviewed, and the remaining client was not able to engage in conversation due to a developmental condition that is not conducive to a meaningful interview; LPA also toured the interior and exterior areas of the Group Home's physical plant and observed no Building & Ground deficiencies. On 09/17/2021, LPA Cabigon interviewed an involved Probation Officer via phone. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 10/04/2021

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

met_with: Ashley Johnson, House Lead


summary: Complaint Investigation - Substantiated - 1 allegation

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

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 3/2/23 at 1: PM and met with Abe Avila, Regional Director to discuss the allegations and findings. LPA Hill informed Mr. Avila that the investigation included an initial inspeciton on 2/6/23 where documentation was requested. LPA Hill interviewed staff, C1's (see LIC811 dated 3/2/23) regional center representative, biological mother to C1, and reviewed C1's documentation at the facility. Regarding the allegation that child was left unsupervised at the facility, Licensing received an incident report dated 2/2/23 detailing that C1's mother reached out to a facility representative about C1 being at the facility alone and without staff. Interview with C1's mother corroborated this information. In addition, the facility was not locked and the facility was accessible to C1 on this date. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 03/02/2023

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

met_with: Abe Avila, Regional Director

complaint_status: SUBSTANTIATED


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

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 5/17/23 at 12: PM and met with Diane McGill, Administrator to discuss the complaint findings. LPA Hill informed NAME that the investigation included an initial inspection on 2/16/23 followed by the Department's Investigations Branch complete investigation. The investigation was conducted by Investigator Andrew Murrow. The allegation that the facility does not maintain required ratios for high need clients is related to the facility acceping clients that need additional supervision or the one staff to one client ratio (1:1) and not providing the staffing to meet that need. Investigation showed that C1 (see LIC811 dated 5/17/23) required a 1:1 staff person supervising them and since there were two clients in the facility there should have been a minimum of two staff persons at all times but the facility did not provide that level of staffing as needed. This was observed and cited during a case management inspection to the facility on 3/16/23. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/17/2023

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

met_with: Diane McGill, Administrator


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

Investigation Findings:
13An unannounced complaint investigation was conducted byLicensing Program Analyst (LPA) Connie Goldie on 04/04/2024 at 11: AM. During the inspection, LPA met with Ashley Johnson, Program Administrator to discuss the findings of the complaint allegations LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Connie Goldie, at the facility on 02/26/2024 which included a physical plant inspection, 2 staff interviews and a record review of C1's file. LPA Goldie requested C1's face sheet, Individual Program Plan, T-logs for February 2024 and current Behavior Intervention Plan, staff roster, including staff contact information and schedules for the month of February 2024. During the course of the investigation, LPA Goldie interviewed five staff and one witness. LPA conducted record reviews on 03/07/2024 and 03/25/2024 of Ring video clips recorded between 02/12/2024 and 03/25/2024. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 04/04/2024

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

met_with: Administrator Ashley Johnson


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

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 05/01/2024 at 12: PM. During the inspection, LPA met with Rayanna Grayson, House Lead, to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Goldie, at the facility on 03/27/2024 which included a physical plant inspection, a staff interview, and a record review of C1's file. LPA Goldie collected C1's updated Individual Program Plan (IPP), Updated Quarterly Report, T log for 03/15/2024 and Emergency Room documentation for visit on 03/15/2024. During the investigation, LPA Goldie interviewed three staff, C1's Service Coordinator, and one witness. LPA Goldie conducted a record review on 04/04/2024 of C1's Incident Report dated 03/15/2024, video clip at Urban Air Adventure Park, C1's Individual Program Plan updated in February 2024, C1's Quarterly Report, T log notes, and Emergency Room documentation. The client was unable to be interviewed as he is non-verbal. Continued on LIC9099D SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/01/2024

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

met_with: Rayanna Grayson, House Lead


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

Investigation Findings:
13An unannounced complaint investigation was conducted by the Licensing Program Analyst (LPA) Connie Goldie on 05/17/2024 at 03: PM. During the inspection, LPA met with Rayanna Grayson, House Lead to discuss the findings of the complaint allegation. LPA Goldie informed agency staff this case was investigated by LPA Connie Goldie. The initial 10-day complaint inspection was conducted by LPA Goldie, at the facility on 01/30/2024 which included a physical plant inspection, two staff interviews, a client interview, and a record review of C1's file. LPA Goldie collected C1's Individual Program Plan (IPP), Behavior Intervention Plan, admission agreement, staff roster, staff schedules for 01/15/2024-01/25/2024 and CPI certificates. During the investigation, LPA Goldie conducted ten confidential interviews between 01/30/2024 and 05/08/2024. LPA Goldie conducted a record review on 04/22/2024 of C1's Roman Empire progress report, START family crisis plan, Individual Program Plan, and facility Program Statement- Runaway plan- Emergency Intervention Plan. C1 declined to be interviewed and C3 was unable to be interviewed as he is non-verbal. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 05/17/2024

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

met_with: Rayanna Grayson House Lead


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

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 06/27/2024 at 12: PM. LPA Goldie spoke with Rayanna Grayson House Lead to discuss the findings of the complaint investigation and allegation stated above. LPA Goldie informed agency staff this case was investigated by Licensing Program Analyst Connie Goldie. The initial 10-day complaint investigation inspection at the facility was conducted by LPA Connie Goldie on 04/22/2024. At the facility, LPA Goldie reviewed a youth file and interviewed a staff. LPA Goldie obtained the following documentation: C1's updated Individual Program Plan (IPP), C1s face sheet, C1's T log and staff schedule for 04/17/2024. During the investigation, six confidential interviews were conducted between 04/22/2024 and 06/19/2024. C1 was not interviewed as he is non-verbal. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 06/27/2024

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


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

Investigation Findings:
13Licensing Program Analyst (LPA) Connie Goldie arrived at the agency to conduct an unannounced complaint investigation inspection on 06/27/2024 at 12: PM. LPA Goldie spoke with Diane McGil Program, Administrator to discuss the findings of the complaint investigation and allegations stated above. LPA Goldie informed agency staff this case was investigated by Licensing Program Analyst Connie Goldie. The initial 10-day complaint investigation inspection at the facility was conducted by LPA Connie Goldie on 04/22/2024. At the facility, LPA Goldie reviewed a youth file and interviewed a staff member. LPA Goldie obtained the following documentation: C1's Individual Program Plan (IPP), C1 and C2's face sheets, C1's T log for 03/25/2024 and staff schedules for 03/17/2024- 04/27/2024. During the investigation, eight confidential interviews were conducted between 04/22/2024 and 06/19/2024. Continued on LIC9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE KENNETHFACILITY NUMBER: VISIT DATE: 06/27/2024

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

met_with: Diane McGil Program, Administrator


facility_name: PEOPLE'S CARE MARJORAM

raw_content:
Narrative:
... were 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 in placement at this facility was not being switched to the nasal medication due to the physician determining that the resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, neither 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. 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 4PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit to deliver findings for an investigation of the above allegation. Based on record review and confidential interviews, the facility has a resident in care (Refer to LIC 811, dated 8/4/22) with specialized in-home health care needs who has approved 1:1 nursing hours to administer a rectal medication for seizures. The licensee has a nearby sister facility, at which there was a resident who also had specialized in-home health care needs and who also had 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 latter resident's nurse to leave the sister facility to go to this facility to tend to the resident at this facility. Based on confidential interviews, the resident at the sister facility was being switched to a nasal seizure medication for which the care team determined nursing hours would not be required. The resident's file contained documentation signed by the physician verifying that the facility staff... 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 Marjoramfacility 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... were 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 in placement at this facility was not being switched to the nasal medication due to the physician determining that the resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, neither 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. 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 MARJORAMFACILITY NUMBER: 075650141

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


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Additionally, LPA observed a resident's mattress to be stained yellow and brown all over and without a mattress pad or linens while the resident was present at the facility. Second, based on record review and interview, the facility had not submitted all necessary documentation to verify interim administrator qualifications. In order to be qualified, an administrator must provide 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 submitted, followed-up and re-requested resubmission on 12/06/22, received confirmation that documents would be resubmitted by 12/12/22, provided a reminder on 12/19/22, and LPA gave final notice to licensee under sister facility on 12/22/22. Documents have been received, and interim administrator requires an exception request for experience qualification and certification. Overall, documents were not submitted in a timely manner, and records reflect that the administrator is not fully qualified. Third, based on confidential interviews, a witness observed in December 2022 that there were four residents present and only two staff. When the witness arrived, one staff was on a break across the street for an unknown amount of time, ending only a few minutes after witness entered the facility. While that staff was outside, the facility was operating at a 1:4 ratio instead of it's required 1:2 ratio. Lastly, records reflect that medication was administered according to the prescription labels, but the prescription labels could not all be verified and/or there were issues with the prescription. One resident is prescribed medications, including psychotropic medications, by five doctors, but the facility could only verify four as doctors overseeing the resident. Additionally, of the resident's four doctors, two are an adult primary care physician and neurologist, and two are a pediatrician and a pediatric neurologist. The resident is not a minor but is currently being administered medications prescribed by two primary care physicians and two neurologists. Further, only one of the doctors is listed as the prescribing physician on the medication administration records (MARs). These issues combined indicate improper documentation, administration, and overall management of medications. 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, Sections 80078, 84088, 84064, 80022, 84065. 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:

met_with: House Manager April Lindsey; Compliance & Training Specialist Erinique Jones


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 1/18/23, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to open an investigation of the above allegation. LPA met with House Manager April Lindsey and Compliance & Training Specialist Erinique Jones and informed of the purpose of the visit. LPA toured the facility site and grounds and interviewed three staff. All residents in care are nonverbal. Based on confidential interviews, a resident (R1 - See LIC Confidential Names List) requires 24/7 nursing support, funding for which Regional Center has agreed to provide effective 02/01/22, and this is documented in the resident's individualized program plan (IPP) addendum dated 03/08/22. Confidential interviews indicate there is not nurse coverage from 3PM-7AM Monday to Friday or on Saturday and Sunday. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of CCR, Title 22, Section 84078(b) Responsibility for Providing Care and Supervision. See LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Compliant & 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 MARJORAMFACILITY NUMBER: 075650141


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 Food Services and Section Personal Rights, which requires accordance of the personal rights specified in Welfare and Institutions Code section 16001.9, which provides that residents have the right to "attend school and participate in extracurricular, cultural, and personal enrichment activities, consistent with the child's age and developmental level, with minimal disruptions to school attendance and educational stability." An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator, whose signature on this form confirms receipt.

Investigation Findings:
13On 2/6/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted an initial complaint visit. LPA met with Interim Administrator Fanesha Caldwell and QA Specialist Gina Renteria and informed of the purpose of the visit. During visit, LPA conducted confidential staff interviews and a record review. Based on record review, observations of obtained evidence, and interviews, a resident who requires special care in preparation of their meals due to a choking hazard, for which a written plan is in place and in the resident's file, was sent with a packed lunch containing a sandwich with wax paper in it stuck to a slice of cheese. The wax paper was found when a caretaker cut the sandwich in order to be served to resident in small bites, as required by the choking hazard plan. Additionally, based on confidential interviews and observation, a resident does not attend a school or day program and is no longer a minor. The facility was previously cited and advised of the requirements surrounding activities and education on 12/09/2022. However, still the resident has not been placed in an adult placement nor enrolled in a school or day program. 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 MARJORAMFACILITY NUMBER: 075650141

met_with: Interim Administrator Fanesha Caldwell; QA Specialist Gina Renteria


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
...weekends uncovered by nursing staff. It was also revealed that on multiple occasions, including since LPA's last visit, there have been only two staff working, including the nurse, and three residents present, which does not meet the required staff to child ratio when accounting for residents' supervision requirements. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing two citations, of California Code of Regulations, Title 22, Sections Fixtures, Furniture, Equipment and Supplies and Responsibility for Providing Care and Supervision. An exit interview was conducted, appeal rights discussed, and a copy of this report left with Interim Administrator, whose signature on this form confirms receipt.

Investigation Findings:
13On 2/6/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint follow-up inspection. LPA met with Interim Administrator Fanesha Caldwell and QA Specialist Gina Renteria and informed of the purpose of the visit. Based on confidential interviews, observations, and record review, a resident's mattress was in poor condition, stained all over with yellow and brown stains. LPA did not smell an odor, but the mattress had not been properly protected to ensure sanitary condition and good repair. The mattress has since been replaced. Additionally, based on confidential interviews and record review, the facility is not operating within ratio. According to the Regional Center Individualized Program Plan in the file and the most recently obtained care plans from the consulting behaviorist, one resident requires twentyfour-seven (24/7) one to one nursing support, and one resident requires one to one support for a nasal medication which the resident is still prescribed as well as one to one supervision during all meal times. However, interviews and record review indicate that there is only one nurse currently working, leaving Monday to Friday 3PM-7AM and the... 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 Marjoramfacility Number: Visit Date: 02/06/ 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...weekends uncovered by nursing staff. It was also revealed that on multiple occasions, including since LPA's last visit, there have been only two staff working, including the nurse, and three residents present, which does not meet the required staff to child ratio when accounting for residents' supervision requirements. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing two citations, of California Code of Regulations, Title 22, Sections Fixtures, Furniture, Equipment and Supplies and Responsibility for Providing Care and Supervision. An exit interview was conducted, appeal rights discussed, and a copy of this report left with Interim Administrator, 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 MARJORAMFACILITY NUMBER: 075650141

Deficiencies:
84088: (A) An individual bed maintained in good repair; equipped with...a clean mattress

title:
Fixtures, Furniture, Equipment...
(c) The licensee shall provide...the following furniture...necessary for personal care and maintenance of personal hygiene


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
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 80078. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Assistant Administrator Fanesha Caldwell, whose signature on this form confirms receipt.

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


summary: Complaint Investigation - Unsubstantiated

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

met_with: Assistant Administrator Fanesha Caldwell


met_with: Facility Manager Anita Wilson

investigation_findings: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


facility_name: PEOPLE'S CARE PLEIDES

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
...continued from LIC Based upon record review and staff interviews, the allegation proves true. This agency has investigated the complaint and found it to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of evidence standard has been met. Facility cited for violation of California Code of Regulations, Title 22, Division Six, regulation 84065(j)(7): Personnel Requirements- Annual training is in addition to first aid and CPR training, and other training as required in Sections 84065.1 and 84365. Exit interview was completed virtually with administrator, Rodina Ventura, and appeal rights explained, on 6/14/21 at 11:00 am. LPA emailed 9099 and appeal rights to be signed and sent back. There will be a hard copy kept in paper file.

Investigation Findings:
13Licensing Program Analyst (LPA), Stefanie Whitlow, conducted complaint investigation for the allegations stating, "Staff are not CPR certified." LPA conducted interviews with seven staff members, completed facility inspection, using video technology, and reviewed documents pertaining to personnel training requirements as outlined in the program statement plan of operation. Documentation provided by the facility revealed that five of the ten group home staff members have expired CPR certification. In addition, during an interview, one staff member stated they were unaware of the need to renew their CPR certification. Continued on LIC 9099-C... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., Suite Chico, CA Facility Name: People's Care Pleidesfacility Number: Visit Date: 06/14/ 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...continued from LIC Based upon record review and staff interviews, the allegation proves true. This agency has investigated the complaint and found it to be SUBSTANTIATED, meaning the allegation is valid because the preponderance of evidence standard has been met. Facility cited for violation of California Code of Regulations, Title 22, Division Six, regulation 84065(j)(7): Personnel Requirements- Annual training is in addition to first aid and CPR training, and other training as required in Sections 84065.1 and 84365. Exit interview was completed virtually with administrator, Rodina Ventura, and appeal rights explained, on 6/14/21 at 11:00 am. LPA emailed 9099 and appeal rights to be signed and sent back. There will be a hard copy kept in paper file. SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., SUITE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: 347005978

visit_type: Annual

met_with: Rodina Ventura


raw_content:
Narrative:
Continued from LIC 9099... During interviews, six staff members explained they received adequate and extensive training from a Licensed Vocational Nurse (LVN), on how to maintain medication logs, use sterile procedures, and properly store medication. They also reported having job shadowed the process. The staff's descriptions of the training align with the program statement training procedures. One staff member, however, disclosed feeling uncomfortable administering medication because they had only job shadowed prior to being expected to administer themselves, which does not meet the expectations outlined in the facility program statement training procedures. This staff member, however, was initially hired and trained at the Kenneth, People's Care facility, which will be addressed separately. Based upon the comparison between the amount of staff members (5) interviewed who stated that staff do not raise their voice and the one staff who stated they do, as well as upon the evidence of non-violent crisis and de-escalation training taken, the allegation "Staff yell at minors in care," cannot be proven true. Furthermore, based upon the amount of staff members interviewed (6) who stated they received adequate training for administering medication as well as upon the verification of medication provided by file review, the allegation "Unqualified staff are passing out medication," cannot be proven true. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove that alleged violation(s) did or did not occur, therefore the allegation(s) is unsubstantiated. Exit interview was completed virtually with administrator, Rodina Ventura, and appeal rights explained, on 6/14/21 at 11:00 am. LPA emailed 9099 and appeal rights to be signed and sent back. There will be a hard copy kept in paper file.

Investigation Findings:
13Licensing Program Analyst (LPA), Stefanie Whitlow, conducted complaint investigation for the allegations stating, "Staff yell at minors in care" and "Unqualified staff are passing out medication." LPA conducted interviews with seven staff members, completed facility inspection, using video technology, and reviewed documents pertaining to personnel training requirements as outlined in the program statement plan of operation. All staff members interviewed explained that the extensive training they received in non-violent crisis intervention prepared them well for deescalating challenging clients. One staff member revealed they have observed other staff yelling at clients. Five staff members shared, during interviews, that they communicate with clients without raising their voice. Those five were also able to explain how they redirect clients and use positive reinforcement to avoid escalation. One staff member disclosed that they attempt to match the volume of the client's voice, when raised, in order to communicate. The record review provided evidence of staff completing non-violent crisis intervention training. Continued on LIC 812-C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Stefanie Whitlow LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, COHASSET RD., SUITE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 06/14/2021


raw_content:
Narrative:
Confidential interviews with S1, S2, S3 and S4 corroborate that staff has not engaged with minors in an inappropriate manner. C1 stopped interview prior to answering all questions. LPA Goldie attempted to contact previous Program Administrator, who relocated out of state, with assistance from the Investigation Bureau but, was unable to gain accurate contact information. C2 and C3 are non-verbal and unable to be interviewed. LPA determined insufficient evidence was provided to support whether staff engaged in an inappropriate manner with minor or not. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No citations were issued today. An exit interview was conducted with Daniel Anderson at 11: AM. A copy of this report along with appeal rights were discussed and provided.

Investigation Findings:
13On 06/17/2022, Licensing Program Analyst (LPA), Connie Goldie met with Lead Facility Manager, Daniel Anderson at 11: A and explained the purpose of the visit was to deliver complaint findings for the above allegation. LPA Alyssa Burgess initiated the complaint at the above named facility on 02/25/2022 and met with staff Daniel Anderson regarding a personal rights violation allegation. During the course of the investigation, LPA Goldie investigated the complaint that "Staff engaged with minor in an inappropriate manner" LPA Goldie conducted a records review of documentary evidence on 03/30/2022. LPA Goldie conducted a physical plant inspection of the home on 04/01/2022 and interviewed three staff. Lead staff 2 stated that both clients in care are non-verbal and Program Administrator confirmed this to be true. LPA Goldie interviewed C1 on 04/01/2022. LPA Goldie interviewed one staff on 05/19/2022. LPA Goldie attempted to contact previous Program Administrator on 06/01/2022 but, contact information is incorrect. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Connie Goldie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 06/17/2022

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

met_with: Lead Facility Manager Daniel Anderson


raw_content:
Narrative:
An attempted interview with Foster Youth on 2.28.2023.LPA was unable to interview Reporting Party due to multiple calls with no return phone call. Interview with Administrator stated that there were problems with communication with the old Administrator in that when the Foster Youths school would call the Administrator they would not get a return call back. The Administrator has since given the School Director her cell number that she can call to discuss the care of the Foster Youth. Interview with Staff 1, Staff 3, Staff 4, and Staff 5 all stated that the new Administrator has been in communication with the school Director since she has started the position at the facility. LPA was not able to interview School Director/Reporting party as multiple phone calls were made where the LPA left her number for a return call, but the calls were not returned. As a result of the investigation and interviews conducted, the allegations that staff are not available to provide information about client's care is SUBSTANTIATED at this time meaning that the preponderance of the evidence standard has been met. An exit interview was conducted with Quinisha silva, DSP 2. A copy of the report and the appeal rights were provided to the facility.

Investigation Findings:
13Licensing Program Analyst (LPA)Jennifer Baca arrived at the agency to conduct an unannounced complaint inspection on 3.14..2023 at 12: Pm. LPA Baca spoke with Quinisha SIlva, DSP 2 to discuss the findings of the complaint investigation and allegations stated above. LPA informed agency staff this case was investigated by LPA Baca. The initial 10-day complaint investigation inspection was conducted at the agency on 2.21.2023. Documents were obtained on 2.21.2023, including staff schedule, staff training record, and staff contact information. Documents regarding foster Youth included the needs and services, and daily activity schedule. Interviews were conducted with the Administrator of 2.21.2023, Staff 1 or 2.24.2023, Staff 3 or 2.24.2023, Staff 4 on 2.28.2023. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Jennifer Baca LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., STE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 03/14/2023

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

met_with: Quinisha Silva, DSP2


raw_content:
Narrative:
Administrator Hamilton stated the facility has a regular training schedule that has been implemented for all staff. LPA Baca observed training records of staff and compared these records to staff members on the LIC500. LPA Baca noted that staff had been trained appropriately. As a result of the investigation and interviews conducted, the allegation staff are not properly trained is unsubstantiated meaning the allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. LPA Baca investigated the allegation that facility staff did not intervene when a resident engaged in inappropriate behaviors. Interviews with Administrator, S1, S2, S3, S4 and S5 all stated that they redirect C1 when inappropriate behaviors are occurring. Staff will redirect C1 to his bedroom or the bathroom. Interviews with S1, S3, S4 and S5 stated that the inappropriate behaviors do not happen very often, but when they do, C1 is able to be redirected. Interview with Administrator confirmed staff's statements and Administrator confirmed that C1 is redirected to their bedroom when inappropriate behaviors happen. The specific incident provided by RP could not be corroborated by staff. LPA Roberts interviewed C2 on 7/11/23 and C1 on 7/17/23. Based on the investigation, observations, information reviewed, and interviews conducted, the complaint allegation that facility staff did not intervene when the client engaged in inappropriate behaviors is unsubstantiated, meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. End of report.

Investigation Findings:
13On 7/17/2023 at 1:00 p.m. Licensing Program Analyst (LPA) Monica Roberts and Licensing Program Manager (LPM) Jodean Hall arrived at the facility to conduct an unannounced complaint inspection. LPA spoke with Kourtney Hamilton, Administrator, to discuss the findings of the complaint investigation and the allegations stated above. The complaint was investigated by LPA Jennifer Baca and LPA Monica Roberts. The initial 10-day complaint investigation inspection was conducted on 2.21.2023. Staff and client records were obtained, included but not limited to staff schedule, training records, Individual Program Plan and Needs and Services Plan for Client 1 (C1), activity schedule, prescription documentation, daily notes, incident reports, and C Personal. Interviews were conducted with the administrator, Kourtney Hamilton, S1, S3, S4 and S5 between 2/21/2023 and 2/27/23 and S6 on 6/2/2023. LPA Roberts interviewed C2 on 7.11.23 and C1 on 7.17.23. LPA Baca investigated the allegation that facility staff are not properly trained. Interviews with Administrator, S1, S3, S4 and S5 all stated they are trained appropriately to conduct the duties of the job.(continued on LIC9099 - C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., STE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 07/17/2023

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

met_with: Kourtney Hamilton, Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Document was created in error. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION NO. Cal Cr/res., Natomas Park Dr., STE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 07/17/2023


raw_content:
Narrative:
Investigation demonstrated that C1 originally alleged that S1 "punched" them with a closed fist but when C1 was interviewed, they were unresponsive to questions being asked and did not specify how their injuries were sustained. Other interviews indicated that C1 has aggressive tendencies toward staff including charging at them, spraying water and soap on the kitchen floor causing the floor to be slippery so staff would fall if attempting to follow C1 throughout the facility and outside. In addition, C1's additional behaviors include punching holes in wall(s), causing property damage throughout the facility, self harm, including banging their head on walls, door frames, and scratching themselves, to name a few. Interviews with other staff members present during the alleged incident denied seeing S1 be aggressive towards C1 or strike C1 in any way. All individuals present indicated that C1 had sprayed water and soap on the kitchen floor causing it to be slippery, resulting in C1 falling several times during the alleged incident, hitting their face and body, sustaining the described injuries. Staff interviewed also indicated that the facility is "hands off" meaning their protocol is to evade client aggression and to not engage in restraints for their safety and the safety of clients in care. Facility staff are currently being trained in a different behavior intervention program but will continue to not restrain clients in care. As a result of the investigation, interviews conducted, and documentation reviewed, the allegation that staff physically assaulted client (C1) which resulted in injuries is UNSUBSTANTIATED meaning the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Ms. McGill and documentation was provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 6/5/24 at 3: PM and met with Diane McGill, Administrator to discuss the complaint findings as stated. LPA Hill informed Ms. McGill that the investigation included an initial inspection on 4/17/24 where documents were obtained for C1 and C2 (see LIC811 dated 6/5/24) and other documents were requested regarding staff that work in the facility. The investigation and interviews were conducted by the Department's Investigation Branch, Investigator Melissa Bennett. The investigator interviewed two clients, four staff, an interview with staff at C1's school, and two Alta California Regional Center staff as part of the investigation. The allegation that staff physically assaulted a client (C1) which resulted in injuries is related to an incident that took place in the facility on or about 4/8/24 where C1 suffered injuries of their eye, lip, and chest area. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Tamara Jensen-Hill LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 06/05/2024

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


raw_content:
Narrative:
On 7/24/2024, when LPA was inspecting the client's room, a staff was in their bathroom mopping. When LPA entered the bathroom, a strong scent of marijuana was present. When LPA interviewed that staff, he denied being high and denied smoking at the facility. The staff stated the smell is probably from their jacket, when they smoked in their own free time. During interviews with staff, LPA was informed by the two staff who were smoking in front of the client the day of the picture being taken, that it was only a nicotine vape, that sometimes the client is out there with them, but they try to have the client go inside. The other staff that was in the picture initially denied anyone smoking in front of the client, but when showed the picture and asked about it, stated that on a rare occasion the client will be out there, but not usually. All three staff denied smoking marijuana at the facility, or staff being high while working. The staffs' stories were corroborative in that two staff share a nicotine vape, and since the job is stressful, they will take a puff on the nicotine vape outside. LPA also learned through interviews with staff that one of their neighbors makes frequent unreasonable complaints about the facility. LPA was informed by staff that when they would go out front to smoke, the neighbor would complain, so they did it in the backyard instead. One staff showed LPA the vape he uses and it is a disposable nicotine vape. The staff demonstrated to LPA the puff from the vape and it had no scent of marijuana, only flavoring, like a nicotine vape. During an interview with a staff, LPA learned that the client's marijuana vape pen smells of marijuana when smoked. Due to staff smoking on facility property and in the presence of a client, the facility is being cited for a violation of the California Code of Regulations, Title 22, Division 6, Chapter 5, Buildings and Grounds, 84087(c). Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with QA/Admin and a copy of this report and appeal rights was provided to her.

Investigation Findings:
13Licensing Program Analyst (LPA) Alyssa Burgess made an unannouced complaint investigation inspection at the facility and met with Gina Renteria, Quality Assurance/Interim Administrator, who assisted with the inspection. LPA investigated this complaint by reviewing security video footage, pictures, emails, smelling the vape vapor, observing the vape unit the staff had, and by interviewing the Reporting Party/witness, three other witnesses, four staff, and the Administrator on 7/29/2024. The pictures LPA reviewed showed three staff outside in the facility backyard smoking in front of a client. All witnesses and the reporting party stated they smell marijuana and stated that it is coming from the facility. The witnesses stated the staff are smoking the marijuana, however, only one of them were able to ever see the staff smoking anything. The three other witnesses have not seen the staff smoking, but smell marijuana in the general vicinity. None of the witnesses know that the client there does smoke from a marijuana vape, per prescription. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PEOPLE'S CARE PLEIDESFACILITY NUMBER: VISIT DATE: 08/13/2024

met_with: Gina Renteria


facility_name: PEOPLE'S CARE RESMAR

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 were attempted with three of three clients, however clients were not able to be interviewed due to 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 1:00 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Program Representative Otilli Abuka of People's Care Resmar to discuss the investigative findings for the allegation noted above. On August 25, 2021, at 2:00 p.m., Licensing Program Analyst (LPA) Marisol Lopez met with Program Representative Otilli Abuka to conduct an unannounced initial complaint investigation. LPA 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 program representative, attempted interviews with three of three clients (C1-C3), and reviewed incident reports. On 08/20/2021, the Department received allegations that staff #1(S1) handled client #1(C1) in a rough manner. It was reported C1 grabbed S1's hair and S1 poured a cup of water on C1 to get C1 to let go of S1's hair. Confidential interviews contradicted the information stating there have not been any incidents involving S1 pouring water on C1. (see continuation form LIC 9099-C dated 06/01/22) 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 RESMARFACILITY NUMBER: VISIT DATE: 06/01/2022

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

met_with: Otilli Abuka


raw_content:
Narrative:
Confidential interviews contradicted the information stating that staff have never provided any non-medically approved substances to any client and that the program administrator is available to speak to the case workers daily. Confidential interviews denied the allegations occurred however, other information provided alleged the incidents occurred and no other witnesses were available. Based on confidential interviews, the allegations that facility staff gave client#1 (C1) a non-medically approved substance and facility staff is not communicating with case managers while in care 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 Facility Administrator Levy Middlebrooks.

Investigation Findings:
13On August 12, 2022, at 12:10 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Facility Administrator Levy Middlebrooks of People's Care Resmar to discuss the investigative findings for the allegations noted above. On November 09, 2021, at 11:45 a.m., Licensing Program Analyst (LPA) Marisol Lopez met with Program Manager Otilli Abuka to conduct an unannounced initial complaint investigation. LPA conducted a safety inspection and no deficiencies were observed at that time. During the investigation, LPA conducted confidential interviews with one case worker, one program administrator, one program manager, four staff (S1-S4), one of three clients (C1-C3) interviews was attempted however C1 refused and clients (C2-C3) were unable to answer LPA's questions. On November 08, 2021, the Department received allegations that facility staff gave client #1 (C1) a non-medically approved substance and facility staff is not communicating with case managers. 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 RESMARFACILITY NUMBER: VISIT DATE: 08/12/2022

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

met_with: Levy Middlebrooks


raw_content:
Narrative:
a resident, and staff spoke inappropriately to resident. It was reported that staff picked up the resident from school, kissed them on the cheek, and referred to themself as the resident's boyfriend. Confidential interviews reviewed S1 was assigned to C1 as their one-on-one staff and did not refer to themself as their boyfriend or kiss C1 on the cheek while at the facility. Confidential interviews revealed S1 was not left alone with C1 and S1 displayed appropriate boundaries with C1. While other interviews revealed that S1 referred to C1 as beautiful in Spanish and could be their boyfriend. Based on confidential interviews and records reviewed that staff inappropriately touched resident and staff spoke inappropriately to resident, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was discussed with Levy Middlesworth, Facility Administrator. Due to printer malfunction, a copy of this report, along with the LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file

Investigation Findings:
13On September 2, 2022, at 1:25 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Levy Middlesworth, Facility Administrator, to discuss the investigative finding for the allegationslisted above. LPA Marisol Lopez conducted an inspection of the facility on 10/12/2021 at 2:00 pm and no deficiencies were observed. LPA Linley conducted an inspection of the facility on 08/12/2022 at 2:30 pm. No deficiencies were observed. During the investigation, LPA interviewed seven out of nine staff (S1, S2, S4-8), C1's teacher (ETA), attempted interview with one of one client (C1), and was unable to interview due to being unable to answer LPA's questions, and was unable to interview C1's Behavior Analyst (BA), a representative from the Behavioral Health organization (REP), and an official from the school district (GSD), due to multiple attempts to contact them. LPA also reviewed the following documents: C1's Individual Program Plan (IPP), C1's annual plan, and S1's employee file. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 RESMARFACILITY NUMBER: VISIT DATE: 09/01/2022

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


raw_content:
Narrative:
Confidential interviews reviewed conflicting statements, some interviews revealed that C1's diaper was checked before they got on the bus to go to school, some interviews indicated that the facility was notified by the school about the soiled diapers, while other interviews revealed that C1 drank liquids before getting on the bus and could have soiled their diaper while riding the bus to school. Based on confidential interviews and records reviewed the staff sends C1 to school with soiled diapers which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was discussed with Levy Middllebrooks, Facility Administrator. Due to printer malfunction, a copy of this report, LIC 811, and appeal rights will be emailed to the Administrator. A copy of this report will be placed in the facility file. reside in the facility. Confidential interviews revealed it is unknown if an age exception was submitted to CCL for C1 to remain in the facility past their 18th birthday. Records reviewed indicated that C1 turned 18 years old prior to the allegation and that the facility did not have an age exception for C1 to reside at the facility after their 18th birthday. Based on confidential interviews and records reviewed, the preponderance of evidence standard has been met regarding the allegation that the facility is operating beyond the license conditions and limitations. This posed a potential Health, Safety, or Personal Rights risk to C1 in care, the facility will be cited for violating Title Regulations, Division 6, Chapter 1, Article 3 80024(a)(2) Waivers and Exceptions.

Investigation Findings:
13On September 2, 2022, at 1:55 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Levy Middllebrooks, Facility Administrator, to discuss the investigative finding for the allegation listed above. LPA Carol Anderson conducted an inspection of the facility on 09/09/2021 at 3:10 pm and no deficiencies were observed. LPA Linley conducted an inspection of the facility on 08/12/2022 at 2:30 pm. No deficiencies were observed. During the investigation, LPA interviewed seven out of nine staff (S1, S2, S4-8), Regional Center Service Coordinator (SC), attempted interview with one of one client (C1), and was unable to interview due to being unable to answer LPA's questions, and was unable to interview C1's teacher (ETA), despite multiple attempts to contact them. LPA also reviewed the following documents: C1's Individual Program Plan (IPP), C1's annual plan, and client roster. On August 1, 2021, Community Care Licensing received an allegation that staff sends C1 to school with soiled diapers. It was reported that C1 was sent to school with soiled diapers and soiled clothing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 RESMARFACILITY NUMBER: VISIT DATE: 09/02/2022

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