summary: Facility Evaluation

raw_content:
Narrative:
On 05/08/2024, at 2: PM, Regional Manager, Margo Castaneda, Licensing Program Manager (LPM) Jodean Hall, Licensing Program Analysts' (LPA's) Connie Goldie, and Alyssa Burgess conducted a Non-Compliance Review Meeting via Teams. Present from Peoples Care is: John O'Brien, NorCal District Manager, Michelle Mainez, Chief Operating Officer, Diane McGill, Program Administrator, and Quinisha Silva, Program Administrator. Present from Alta Regional Center is: Toby Golden, Client Services Manager. The purpose of the office meeting is to review the current status of Non-Compliance plan. The following NCC primary areas of concern were reviewed: supervision, staff to child ratio, training, reporting requirements, vape pen and board accountability. It was acknowledged that Peoples Care Quality Assurance created and implemented a training program and have continued to conduct ongoing training as requested. Incident reporting has increased. The compliance for each location: People's Care Shawmutt, People's Care Kenneth, and People's Care Pleides was reviewed for the time period of May 2023- May 2024. The following current existing concerns were discussed: staffing to meet the needs of clients in care, not utilizing the emergency intervention plan as identified in facility's plan of operation when required and board accountability. Based on record reviews, the Shawmutt and Pleides locations have not had one complaint opened in the last 12 months and the citations issued have decreased. As a result, these locations will be removed from the non-compliance plan. The Kenneth location has had increased complaints and increased citations and will remain on the NCC for an additional six months. Increased oversight will remain in effect through 11/08/2024. Continued on LIC809C The Department requests a revision of the Emergency Intervention plan be submitted within thirty days with clear directives on each of the different techniques and when they will be utilized along with the verification that staff have been trained on the use of the techniques outlined based on defined behaviors. An Administrator Exception Request needs to be submitted to the Department immediately. A copy of this report was provided via email to John O'Brien, District Manager for signature.

met_with: John O'Brien District Manager


state: CA

facility_name: PEOPLE'S CARE KENNETH

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 05/14/2024, at 10: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/required inspection. LPA Goldie was greeted by Diane McGill, Program Administrator, (PA) in the driveway. Upon arrival, LPA provided Entrance Checklist to PA McGill who assisted LPA with the inspection. LPA toured facility with S1 and observed a 4 bedroom, 2 bath single story home with a living room and family room providing adequate seating for clients/staff. The temperature was observed to be a comfortable 74 degrees. All bedrooms had required furniture per regulation.. LPA observed kitchen to have 5 days of non-perishables in cabinets and refrigerator/freezer with a 2 days of perishables. Refrigerator temperature reads 40 degrees and is compliant with regulation. Dining area has a large dining table with seating for 6. LPA observed towels in all bathrooms. The water temperature was observed to be 105.4 degrees which is compliant. LPA observed hygiene products to be available to clients. LPA observed phone available for client use to be portable. LPA observed one shed in the backyard, secured. Equipment was observed to be available for clients to participate in activities outside including a trampoline. Backyard was clear of debris. LPA Goldie conducted 3 staff and 1 client interviews. CARE Tool components completed during todays inspection include: Physical Plant, Operations, Disaster Preparedness and Emergency Intervention Plan. Two Title Deficiencies were cited during the inspection. See LIC809D A second inspection will be needed to complete the Annual inspection. LPA Goldie conducted an exit interview with Ms McGill at 03: PM and provided a copy of this report along with appeal rights.

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

report_type: Facility Evaluation

visit_type: Annual

met_with: Diane McGill Program Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 05/24/2024, at 09: AM, Licensing Program Analyst (LPA) Connie Goldie met with Diane McGill, Program Administrator to continue unannounced/required Annual inspection. Ms. McGill stated that two staff are currently in the facility. All residents are at school.. Monique Harris, DSP staff (S1) assisted LPA with inspection. Care Tool domains Staffing Records and Client Records were completed during today's inspection. LPA Goldie conducted 1 client interview C2 and staff interview S4. LPA reviewed 5 staff records, 2 client files and medication administration records. The following Title 22 citations are being cited today- Type B deficiencies. One technical violation and one technical advisory were issued. These are not deficiencies. Annual inspection is complete. LPA conducted exit interview with Ms.McGill at 4: PM. A copy of this report along with appeal rights was left at the facility.

Deficiencies:
80026(h): Safeguards for Cash Resources, Personal Property, and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 05/23/2025, at 09: AM, Licensing Program Analyst (LPA) Connie Goldie made an unannounced visit to conduct an Annual/Required inspection. LPA Goldie was greeted at the door by Schirrell Ellison, (S1) Direct Support Professional DSP II. S1 called Program Administrator, Vanessa Baldwin who stated she was on her way. S1 stated she is the only staff present. The client is home from school today. LPA Goldie provided S1 the Entrance Checklist and obtained the following documents: LIC 309, LIC500, LIC402, and LIC610C. LPA toured facility with Administrator and observed a 4 bedroom, 2 bath single story home with a large living room that has adequate seating for clients/staff. The temperature was observed to be a comfortable 71 degrees Fahrenheit. Bedrooms had appropriate furnishings and occupied room had youth's preferred decor. LPA tested combined smoke/carbon monoxide detectors and found them to be in working order, LPA observed kitchen to have a pantry with 5 days of non-perishables and refrigerator/freezer with 2 days of perishables. Refrigerator temperature read 34 degrees Fahrenheit. Dining area has adequate seating for clients. Family room has additional area for activities. LPA observed soap and towels in both bathrooms. The water temperature was observed to be compliant in kitchen and bathrooms. LPA observed hygiene projects to be available to client. Backyard was clear of debris. LPA observed facility van to be in safe driving condition, headlights working, tire tread appropriate, first aid kit present and all seat belts working. Maintenance log was also reviewed. LPA informed Administrator that annual fees are past due and communicated that this needs to be addressed. LPA verified that all staff are background cleared. Care Tool domains have been completed. Continued on LIC809C. LPA Goldie conducted 4 staff interviews S1, S2, S3 and S4. Client C1 declined to be interviewed. LPA reviewed a client file, medication administration records and 4 staff files. . Annual inspection is complete.

met_with: Vanessa Baldwin Administrator Gina Reneria Quality Control Specialist


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on the evidence gathered and the confidential interviews conducted during the investigation, the allegation could not be substantiated. Of the seven individuals interviewed, five stated that facility staff did not engage in any inappropriate interactions with youth. The remaining two individuals provided conflicting statements that could not be corroborated. The alleged incident was reported to have occurred sometime between 2021 and 2022; however, LPA was unable to confirm an exact date. As a result, it was not possible to determine which staff members may have been present at the time of the alleged incident. LPA was unable to conduct interviews with certain individuals who were employed during the relevant time frame, including previous facility administrators and the youth service coordinator. Additionally, all former staff interviewed stated that no concerns or reports were made regarding S1 engaging in inappropriate behavior with youth during their time at the facility. Also, LPA was unable to verify additional details regarding the incident through documentation, as it was not reported at the time it allegedly occurred. Lastly, documentation states youth involved has a documented history of dishonesty. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted. A copy of this report and appeal rights were provided to Mauricio Villatoro, Regional Director.

Investigation Findings:
13On November 25, 2025, Licensing Program Analysts (LPAs) Sarina Buchannan and Jean Stidman made a visit to deliver findings and met with Mauricio Villatoro, Regional Director. LPAs delivered findings at an alternate location due to the facility being closed. Prior to the meeting, LPA Buchannan requested the following documents: client roster (LIC 9020), staff roster (LIC 500), staff contact information, client face sheets, client Needs and Services Plan, and disciplinary log/corrective action paperwork for staff in question. LPA Buchannan conducted 7 confidential interviews between 09/04/2025-11/11/2025. (report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Connie Goldie LICENSING EVALUATOR NAME: Sarina Buchannan 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: 11/25/2025

report_type: Complaint Investigation

met_with: Mauricio Villatoro, Regional Director

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 07/16/2025 at 09: AM, Licensing Program Analyst (LPA), Connie Goldie arrived unannounced at Peoples Care Kenneth for the purpose of conducting a Case Management -Incident Inspection regarding two incidents that occurred on 11/08/2024 and 4/23/2025. LPA met with Gina Renteria, Quality Control Specialist (S!) who assisted with the inspection. The incident dated 11/08/2024 reported a medication (M1) error for client (C1). Based on record review, C1 received medication (M1) full dosage and titrated dosage amount for 8 days 10/24/2024-10/31/2024, after a titration order was provided by the physician on 10/22/2024. The incident dated 04/23/25 reported a client (C1) took medication that was in his possession and not prescribed. Both of these incident reports were reviewed with Gina Renteria Quality Control Specialist. Additionally, LPA conducted a client interview with C1. LPA issued a facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, Health Related Services regulation 80075 (k)(1). LPA inspected the facility inside and outside. There were no concerns with the facility inspection. Case management is closed. LPA provided a copy of this report along with appeal rights to Gina Renteria, Quality Control Specialist.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection on 3/16/23 at TIME for the purposes of conducting a case management inspection. At the time of LPA's arrival, staff Arizona Miller, Direct Support Staff was present and assisted with the inspection. LPA Hill informed Mr. Miller that the purpose of the inspection is to address concerns from the 2/16/23 inspection related to the 2/14/23 incident sent to Licensing detailing that C1 and C2 (see LIC811 dated 3/16/23) were unsupervised in C2's bedroom together resulting in C1 inappropriately touching C2. LPA Hill informed NAME that the incident has been investigated and the conclusion of that investigation shows that the facility did not have the proper supervision necessary to meet the needs of C1 and C2 in that C1 is to be staffed on a 1:1 and the facility did not staff to that need. At the time of the incident, the facility only had one staff present and working. S1 had gone over to the medication cabinet to get medications ready for administration, making it impossible to provide the supervision to C1 and C2 while completing this task. Following this incident, C1 left the facility and S1 could not follow as a result of being the only staff in the facility. As a result of both of these issues, the facility was cited for California Code of Regulations, Title Regulation 84078(b) Responsibility for Providing Care and Supervision. The facility failed to provide those services identified in each child's needs and services plan (Individualized Program Plan)...as necessary to meet the child's needs. Also discussed during the inspection was that the facility has not complied with the citation issued on 3/2/23 resulting from a complaint investigation. The plan of correction agreed upon on 3/2/23 indicates that the facility was to provide a weekly schedule to Licensing for the next 60 days indicating all the staff to be present at the facility on a weekly basis. The administrator has only provided LPA Hill with their own work schedule since this inspection. As a result, the facility was re-cited for California Code of Regulations, Title Regulation 80078(a) Responsibility for Providing Care and Supervision and Regulation 84072(d) Personal Rights and given new due dates of 3/20/23 in which the facility shall provide weekly schedules to LPAs Hill and Roberts as requested. LPA Hill also discussed with Mr. Miller two of the citations issued during the annual inspections on 3/13/23 and 3/14/23, were either duplicative in nature or not applicable to this facility. LPA Hill explained that for one of the citations, while the citation number is not duplicated, the regulations themselves relate to the same issue and the intent is the same. Another one of the citations is related to a facility that is licensed for six or more clients and this facility is only licensed for four. As such, two of the LIC809Ds issued on 3/13/23 were amended to remove these citations. LPA Hill provided the facility with the updated documents to remove the discussed citations. Lastly, LPA Hill informed Mr. Miller that the case management inspection is being conducted today for the purposes of assessing civil penalties for three citations issued during the annual inspection on 3/13/23 and 3/14/23. The three identified repeat violations are 84070(b)(12) Children's Records as this citation is related to the facility not obtaining written authorization for psychotropic medication being administered to C1 and C2; 84070(b)(13) Children's Records as this citation is related to psychotropic medications needing a separate psychotropic medication administration record for each psychotropic medication prescribed to C1 and C2; and 84077(a)(2) Personal Services as the facility was not providing allowances to the clients in care. All of these repeat violations were previously cited on 7/6/22 during the annual inspection. LPA Hill informed NAME that the repeat violations assess are $250 per violation for the first day, and then $100 per violation, each day until the violation is corrected per Provider Information Notice 17-02-CCLD. LPA Hill observed that staff at the facility staff was preparing the Psychotropic Medication Administration Records (PMARs) for C1 and C2 on 3/14/23. As such, this civil penalty for 84070(b)(13) is assess for one day only, 3/13/23. The other two civil penalties will continue until the facility provides proof of correction as prescribed in the annual visitation reports for 3/13/23 and/or 3/14/23. When LPA Hill arrived at the facility on 3/16/23, it was observed that two staff were present but LPA Hill observed that S2 was sleeping in the living room area of the facility. LPA Hill contacted the Regional Director Abe Avila to inform him of what was found upon arrival at the facility. LPA also informed Mr. Avila that the facility will be cited for 84065.2(b)(1) Personnel Duties as the staff at the facility are required to perform duties including the supervision, protection and care of children individually and in groups at all times. LPA Hill informed Mr. Avila that this is not happening when staff are asleep while clients are present. Exit interview was conducted with Mr. Miller and Mr. Avila and documents were provided to the facility along with the appeal rights.

met_with: Arizona Miller, Direct Support Staff


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced case management inspection on 4/12/23 at 3: PM and met with staff Jessica Beckel, Direct Support Provider, who assisted with inspection today. LPA observed that one staff, Arizona Miller, was leaving the premises as LPA Hill arrived as the staff and a client were going on a walk. LPA Hill spoke with the appointed administrator, Erinique Jones, via phone who stated that she was home sick today and unable to respond to the facility. LPA Hill informed Ms. Jones that the department is in receipt of the documentation provided for the administrator position and need additional documentation, including an LIC500 indicating the days and times that Ms. Jones would be physically present in the facility along with documentation that was submitted for the renewal of the group home administrator certificate as the current certificate expired 3/30/23. LPA Hill also advised Ms. Jones that the LIC501 that was submitted with the other documentation states that Ms. Jones resides approximately five hours from the facility and that this would prohibit her being the named administrator at this location. Ms. Jones states that she will consult with administrative staff about this and have them get back to Licensing about this. LPA Hill advised Ms. Jones that she was there to follow up on some of the previous citations issued during the annual inspections 3/13/23 and 3/14/23 and the case management inspection conducted 3/16/23. LPA Hill did provide some clearance documents for some of the citations issued. LPA Hill did observe that the posted schedule still shows only one staff person at the facility from 6 am to 2 pm, Monday through Friday. LPA Hill also noted that this is the same schedule that was provided for the week of 4/2/23 to 4/8/23 where LPA identified that this was an issue and no response was received. In addition, LPA Hill notified the agency via email 4/4/23 at 1:: PM, that there were other issues with the schedule, leaving the facility with only one staff present with two clients, C1 (see LIC811 dated 4/12/23) is a 1:1 client and needs to have their own staff person present. This correspondence was provided to Abe Avila, Diane McGill, and John O'Brien via email by LPA Tamara Hill. LPA Hill did cite the facility on 4/12/23 for 84078(b) Responsibility for Providing Care and Supervision as the facility is required to provide the 1:1 staffing required during the morning shifts, Monday through Friday, and other times throughout the week where only one staff is present with both clients as indicated on the staffing schedule posted in the office and provided to Licensing on a weekly basis. LPA Hill informed the facility that further clearance of the citations issued in March 2023 shall continue and LPA Hill shall return to verify clearance of other citations not verified via email or through other means. Exit interview was conducted and document was provided

met_with: Jessica Beckel, Direct Support Provider


summary: Facility Evaluation

raw_content:
Narrative:
On 06/27/2023, at 10: AM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced case management visit to follow up on the Non-Compliance plan, (NCCP) provided to facility during Non-Compliance Conference meeting held on 05/09/2023. LPA Goldie was greeted by S1 who stated clients were at day program. S1 stated Program Administrator would be in shortly. LPA conducted walk through with S1. LPA observed a single story four bedroom, two bath home. LPA observed two client bedrooms with adequate furniture and bedding, and two vacant bedrooms. LPA observed bathrooms to have soap and towels as required. In garage, LPA observed an unsecured cabinet with chemicals. S1 stated she was uncertain as to who left it unlocked but, probably a noc staff. LPA stated a citation would be given as chemicals are required to be secured per regulation. Kitchen was observed to have sufficient non-perishables and perishables. LPA observed a broken trampoline in the backyard which was damaged according to S1 on 06/26/2023. A work order was provided to LPA. Smoke detectors were tested and compliant. LPA interviewed 4 staff and 2 youth during visit. LPA reviewed schedules for previous 30 days and observed no new hires. Administrator has been at facility more than the 20 hours required. LPA discussed bi-weekly trainings and learned that on 06/23/ Disaster training and Driving guidance manual were topics of training. LPA observed sign-in sheet with agenda. Continued On LIC809C Facility is being cited for one Title 22, Division 6, Chapter 1 violation, Buildings and Grounds 80087 (g)(1). See LIC809D. Additionally, a technical violation was given for Administrator (PA) being disassociated to facility in Guardian. This is not a deficiency. Association was re-established during visit. A copy of this report along with appeal rights was provided to and discussed with Administrator.

met_with: Elizabeth Harton DSP2 Diane McGill Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/14/2023, at 11: AM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced case management visit to deliver report for inspection conducted on 09/07/2023 between 12: PM and 3: PM. LPA was unable to complete report on 09/07/2023 as a client had a behavior which escalated to an unsafe level for the LPA to stay resulting in LPA's computer being destroyed. LPA Goldie made an unannounced inspection on 09/07/2023 to conduct quarter two follow up on the Non-Compliance plan, (NCCP) provided to facility during Non-Compliance Conference meeting held on 05/09/2023. LPA Goldie was greeted by S1 who stated clients were at school. S1 contacted Program Administrator who said she would come in shortly. LPA interviewed 3 staff and 1 youth during visit. LPA reviewed LIC 500 and schedules for previous two weeks and observed 3 new hires. Administrator has been at facility more than the 20 hours required. LPA discussed bi-weekly trainings and observed that trainings are ongoing as requested. LPA discussed need for consistency regarding hiring updates bi-weekly for vacancies in facility and status regarding Administrator in each home as directed in the non-compliance meeting held on 07/20/2023. LPA received updated Needs and Service plan for C1 and C2. Continued on LIC809C LPA did a record review of Medication Administration Records (MAR) and observed two Title 22 deficiencies which are being cited today. LPA observed that two of two clients had missing quantity of medication and number of refills listed on their psychotropic medication administration records. Additionally, one of two clients had a psychotropic medication administration record that listed incorrect prescribed dosage and directions for use. See attached LIC809D. LPA conducted walk through with S3. LPA observed a single story four bedroom, two bath home. LPA observed two client bedrooms with adequate furniture and bedding, and two vacant bedrooms. LPA observed bathrooms to have soap and towels as required. In garage, LPA observed chemicals to be secured as required. Kitchen was observed to have sufficient non-perishables and perishables. LPA observed backyard to be free of debris and shed secured. Exit interview was conducted with Program Administrator and a copy of reports along with appeal rights were discussed and provided to facility.

met_with: Rhynada Long Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 02/26/2024 at 12: PM, Licensing Program Analyst, (LPA) Connie Goldie conducted an unannounced visit and met with staff . LPA Goldie conducted a walk through of the facility The facility is free of clutter. Resident and Staff files are in locked cabinets located in staff office. There is two days of perishables and seven days of non-perishable food supply. Snacks are accessible to the clients. Licensing certificate and clients personal rights are posted. Smoke Alarm and egress alarms are in working condition. Clients bedrooms are clean and had linen and personal effects in the rooms. In the garage, LPA Goldie observed 9 bags of garbage piled near left back side by exit door to the backyard. Staff stated that the garbage cans were over flowing and that they have not been put in front for at least two weeks. LPA observed five garbage cans over flowing in the backyard. Staff stated the trash cans will be placed on the curb for pick up tonight as pick up is on Tuesdays. LPA stated that this is a regulation violation. Staff agreed. One Title 22 deficiency is being cited today. See LIC809D for details. Exit interview was conducted with staff. A copy of the report along with appeal rights was discussed and provided.

met_with: Monique Harris DSP Lenell Richardson DSP


summary: Facility Evaluation

raw_content:
Narrative:
On 03/28/2024, at 01: PM, Licensing Program Analyst, (LPA), Connie Goldie made an unannounced case management Quarter Non-Compliance plan, (NCCP) inspection. LPA Goldie was greeted by facility manager Rayanna Grayson who stated two clients are present. S1 called Administrator, Ashley Johnson, who arrived at 01: PM to assist with the inspection. LPA conducted a walk through of home inside and out during case management inspection on 03/27/2024. LPA interviewed 4 staff and 1 youth during visit. LPA reviewed LIC500 to verify staff clearances. All staff are background cleared as required. LPA reviewed Medication Administration Records (MARs) and (PMARs). LPA observed C1 refused medication (M1) on 03/17/2024 that wasn't recorded on day it was refused as refusals for 03/18/2024, 03/19/2024 and 03/20/2024 were listed prior to 03/17/2024 refusal. Administrator agreed that date listed for refusal occurred after date refused. LPA reviewed Cash Resource Logs to verify accuracy of client funds. The agency is being cited for the following Title 22, Division 6, Chapter 5, Article 6, 84070 (b)(13)(B) Children's Records during this inspection. Exit interview was conducted with staff. A copy of the report along with appeal rights was discussed and provided.

met_with: Program Administrator, Ashley Johnson


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 03/28/2024 at 05:30 p,m., an unannounced case management inspection was conducted by Licensing Program Analyst, (LPA), Connie Goldie to follow up on a visit to the facility conducted on 11/16/2023. LPA Goldie met with Ashley Johnson, Program Administrator, who assisted with the visit. During inspection on 11/16/2023, LPA observed an inadequate amount of food in the facility. LPA observed less than ½ gallon of milk, two fruits and limited lunch meat in the refrigerator. Menu items scheduled for the day were unavailable in the home. The Administrator stated grocery shopping was not completed due to staff calling out. During inventory assessment of non-perishable items, LPA Godie and Ms. Johnson identified six expired cans of food in cupboard that were more than seven days past expiration date. AM staff daily checklist and sign off was completed. During the Case Management inspection, Licensing Program Analyst, (LPA) Connie Goldie conducted an audit of Cash Resource Log for C1 and C2 with District Manager (DM) John O'Brien. LPA counted both of the consumers funds in the home. Both clients had inaccurate amounts both favorable to the clients. C1 was over $16.48 and C2 was over $11.05. The agency is being cited for the following Title 22, Division 6, Chapter 5, Article 6, 84076 (c) (1) Food Service, Title 22, Division 6, Chapter 1 Food Services (a) (7) and 80026 (h) Safeguards for Cash Resources during this inspection. Case Management is closed. An exit interview was conducted where the citation and plan of correction were discussed. Appeals rights were provided and discussed with the facility representative mentioned above.

Deficiencies:
84076: ... for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.
80076: ( 7) Commercial foods shall be ... stored, prepared, and served so as to be free from contamination and spoilage ...

met_with: Program Administrator Ashley Johnson

title: (c)The licensee shall meet the following food supply and storage requirements

title: (a) In facilities providing meals to clients, the following shall apply


facility_name: PEOPLE'S CARE MARJORAM

summary: Complaint Investigation - Substantiated - 1 allegation

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:

complaint_status: SUBSTANTIATED


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:


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:


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

met_with: Facility Manager Angela Davis


summary: Complaint Investigation - Substantiated

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

met_with: Facility Manager Maria Gonzvales


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 8/5/21 at 9:58AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with QA Specialist Bree Moore and informed of the purpose of the visit. There were three staff and one resident present. LPA used the inspection tool to conduct the facility inspection. LPA reviewed the files for current residents and staff members. All files were complete. Staff training was current and meets requirements. Staff are cleared and have current CPR and CPI certificates. Resident records were complete. Medications are stored properly and logs are well maintained. The facility is operating according to the license. The facility site and grounds were inspected. The facility is clean and sanitary. There are no obstructions or bodies of water. Per Bree, there are no firearms on the premises. Chemicals and sharps are kept in locked storage closet. Food storage is sanitary, and there is food to meet the needs of the residents in care and that meets the 7-day nonperishable, 2-day perishable mandate. Medications are stored in the locked storage closet. LPA observed that the hot water in the large resident bathroom measured above the permitted range, at 123. F. LPA advised, per Title 22, Section 80088, that the facility have the hot water adjusted so that the temperature does not exceed F. There are no citations. One advisory was provided at visit. An exit interview was conducted with QA Specialist Bree Moore, whose signature on this form confirms receipt.

met_with: QA Specialist Bree Moore


summary: Facility Evaluation

raw_content:
Narrative:
On 8/22/22 at 1:45PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct this inspection. LPA toured the facility and observed residents in care. There are four residents in care, and all are nonverbal. Residents were observed to be supervised and engaged by staff, and one resident had a therapy session with a behaviorist consultant whom facility staff provided assistance. Residents appear clean and dressed in clean, well-fitting clothes and all appeared content or playful. LPA conducted confidential interviews with two staff. Based on confidential interviews, observation, and record review, the facility is clean, bathrooms are sanitary, and activity spaces are free of hazards. Chemicals and knives are stored where inaccessible to residents. Medications are stored where inaccessible to residents, and medication administration records reflect administration is following prescriptions. There is enough food to meet the needs of residents in care. Room temperature is maintained at a comfortable temperature. Beds have clean linens, and bedrooms are kept organized and clean. The following deficiencies were observed. See LIC 809-D and LIC 9102s. 1) Administration of residents' psychotropic medications are not being logged on a separate log but instead are logged on one log. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84070. 2) The needs and services, or Individualized Program Plan (IPP), for two residents (See LIC 811) were not signed by authorized representative and only signed by the previous interim administrator. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84468.3. 3) The kitchen pantry had sticky food residue on two shelves. LPA advises that the facility clean these. 4) Hot water was measured at all three bathroom sinks at 100. F, which is below the required range (lower end is F). LPA advises that hot water is too low. A continuation visit will be conducted to complete this inspection. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/14/22 at 2:15PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual continuation inspection. LPA met with Staff Chassie Thompson and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct this inspection. LPA observed nonverbal residents in care. One resident was napping after an outing, and one resident engaged in activity and with staff, dressed in clean, well-fitting clothes, and appeared to be happy and content. Resident enjoyed a snack with staff. The physical plant and resident records were inspected at the initial visit, and personnel and facility records were inspected at today's visit. The facility was clean and sanitary, and LPA did not see any physical plant violations requiring further inspection. LPA observed files to be complete with some exceptions listed below. See attached LIC 809-D pages. 1) Staff S1 and S2 (refer to LIC Confidential Names) do not have clearances associated to the facility and have both worked for more than 5 days. LPA is issuing a citation of California Code of Regulations (CCR), Title 22, Section Criminal Record Clearances. Additionally, per 80019(g), LPA is assessing an immediate civil penalty of $500 per individual in violation for a total of $1000. 2) Staff S2, S3, S4, and S5 have no valid first aid / CPR certificate in their personnel file. LPA is issuing a citation of CCR, Title 22, Section Health Related Services. 3) Personnel records do not reflect that 20 hours of annual training were completed in the last 12 months for staff hired over 12 months ago or 40 hours (initial training combined with 16 hours of annual training) for staff hired within the last 12 months. LPA is issuing a citation of CCR, Title 22, Section Personnel Requirements. An exit interview was conducted, appeal rights provided, and a copy of this form was provided to the facility. Administrator Rizza Madlangbayan's signature on this form confirms receipt.

met_with: Interim Administrator Rizza Madlangbayan; Staff Chassie Thompson


summary: Facility Evaluation

raw_content:
Narrative:
On 2/6/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Interim Administrator Fanesha Caldwell and QA Specialist Gina Renteria and informed of the purpose of the visit. The purpose of the visit was to follow-up on a submitted incident report regarding a concern with one staff member not fulfilling their care and supervision duties. During visit, LPA conducted two confidential staff interviews. Further investigation is needed. LPA is requesting the most current LIC 500, as the one posted in the facility does not reflect the new administrator. Additionally, LPA is requesting Interim Administrator's personnel records in order to verify qualifications. LPA sent a follow-up email at visit with a list of forms to submit for administrator approval. LPA is requesting that the above items be sent to LPA by 2/7/23 11:59PM. 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.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/21/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Facility Manager Joanna Diaz and Interim Administrator Timothy Haliburton. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA inspected facility and resident records and observed records to be complete and organized. Staff have received training on required topics. The facility is in the process of designating an administrator to be the sole administrator of the facility, and the candidate has been tentatively approved by the licensing agency. The licensee continues to provide hiring updates. All residents in care attend a school program. Both residents in care are above the licensed age range, but the licensing agency has granted age exceptions for both residents. LPA observed the facility to be operating in compliance with the NCC terms. No deficiency citations were issued at today's visit. An exit interview was conducted, and a copy of this report was left with Interim Administrator, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 8/8/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Interim Administrator Vanessa Baldwin and informed of the purpose of the visit. LPA used the CARE Inspection tool to complete this inspection. LPA conducted interviews with two staff and observations of one resident. The second resident was at school. Both residents are nonverbal. LPA toured the facility site and inspected resident and personnel files. LPA observed the facility to be clean and maintained in safe condition. The facility had menu and day plans posted. Staff showed LPA the PECS on resident tablet. LPA observed kitchen and bathrooms in sanitary condition. LPA observed that there was no facility manager on shift. Per the March 2023 noncompliance conference, the facility is to designate a facility manager to be on site every shift, including when the administrator is on site. Based on record review and interview with staff, there are currently no facility managers designated. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. See LIC 809-D attached. A previous citation of this requirement was issued on 12/09/22. LPA is assessing a civil penalty for repeat violation of $250. See LIC 421FC. LPA also advised of the below. See LIC 9102s. -- Grievance procedures were available in the resident files but were not posted. LPA advised that this should be posted in the facility. -- One staff had a health screening but no tuberculosis (TB) test. LPA advised that this should be obtained. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Vanessa Baldwin, whose signature on this form confirms receipt.

Deficiencies:
84065(d): Personnel Requirements

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

met_with: Interim Administrator Vanessa Baldwin


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Interim Administrator Vanessa Baldwin. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA inspected the staff and resident records and observed records to be complete and well-organized. Staff training records reflect that staff have received training on required topics, including facility procedures and de-escalation. Staff have valid first aid and CPI certifications, LVN staff have valid licenses, and facility managers have complete training covering the required topics. The facility is continuing to hire staff to maintain staff to client ratios. LPA observed staff interactions during inspection, including resident de-escalation, and observed staff to communicate well and understand the appropriate facility and de-escalation procedures to follow. The facility has designated an administrator to oversee only one facility. The facility also maintains communication with outside agencies, including Community Care Licensing, Regional Center, and resident schools. LPA observed the facility to be operating in compliance with the NCC terms. No deficiency citations were issued at today's visit, and there are no outstanding plans of correction (POCs). An exit interview was conducted, and a copy of this report was left with Interim Administrator, whose signature on this form confirms receipt.

met_with: Administrator Vanessa Baldwin


summary: Facility Evaluation

raw_content:
Narrative:
On 3/13/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management quarterly inspection visit, per the agreed upon terms of the noncompliance conference (NCC) on March 3, 2023. LPA met with Facility Manager Maria Gonzvales and informed of the purpose of the visit. During visit, LPA inspected facility records for residents and personnel and interviewed staff and resident. Multiple deficiencies were identified but cited on other reports generated on this day. See LIC Case Managements dated 3/13/24. LPA cautions the facility that in the year since the NCC, the facility has received two substantiated complaint findings and 19 deficiency citations. LPA advises that the facility consider contacting the Department or another approved training vendor for additional technical support or training. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Facility Manager Maria Gonzvales, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/30/24 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins and Licensing Program Manager (LPM) Isabel Diego held a meeting with District Manager John O'Brien and Quality Assurance Specialist Gina Renteria. The purpose of the meeting was to discuss the facility's progress in meeting the terms of the noncompliance conference (NCC) held in March 2023. Since the NCC, the licensing agency has made 5 visits to the facility where citations were issued. The areas of deficiency included personnel requirements, training requirements, supervision and staff/child ratios, and resident records. LPA and LPM discussed staff training and documentation, supervision requirements, medical requirements, and facility manager coverage. During the meeting, John gave notice that the licensee is in the process of closing the facility site, citing staffing challenges as the main reason. Following the meeting, LPA sent John and Gina instructions on submitting a closure plan, per PIN 18-03-CRP. A copy of this report was emailed to both representatives.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/3/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit as follow-up on a submitted incident report. LPA met with Administrator Vanessa Baldwin and informed of the purpose of the visit. The incident in question is one in which a staff member spoke inappropriately toward a resident in care, referencing events or matters not appropriate to the age or developmental level of the resident. Upon receipt of the report of the incident, the Administrator met with each staff involved and collected written statements. The responsible staff member denied parts of the report but admitted to making the statements that were inappropriate to have been spoken about with the resident. The Administrator counseled the staff member on appropriate language and topics of discussion and issued a write-up. The staff member was also placed on administrative leave pending the licensee's internal review. No deficiency citations were issued. An exit interview was conducted, appeal rights were discussed, and a copy of this report was left with Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 7/2/24, Licensing Program Analysts (LPAs) Mona Lam and Selena Hood conducted a case management visit at the facility and informed the purpose of the visit. LPAs met with Administrator Vanessa Baldwin who assisted with the inspection. LPAs observed the health care plans for clients, which have been updated, as it is dated March 2024 and April 2024. ***LIC 809 document is amended for citation that was appealed and approved by Licensing Program Manager. Report amended on 10/1/2024.*** No citations delivered. An exit interview was conducted, and a copy of this report was given to Vanessa Baldwin whose signature confirms the receipt of this report. In addition, a cleared LIC809-D page is given to Vanessa Baldwin. LPAs observed that one seizure activity was noted for R1 in June 2024. However, seizure calendar was missing from seizure records binder for the month of June. LVN Anita Wilson printed out the seizure calendar and filed the June seizure calendar into the binder. A technical violation was delivered under 80092.1 (p) General Requirements for Restricted Health Conditions. A facility walk through was conducted. An exit interview was conducted, appeal rights provided, and a copy of this report left with Administrator Vanessa Baldwin and Facility Manager Maria Gonsalves, whose signature on this form confirms receipt.

met_with: VANESSA BALDWIN, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 8-27-24 10:30AM, Licensing Program Analyst George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Maria Gonsalves / Facility Manager House Lead, and toured the facility inside and out. The Group Home is licensed to serve 4 clients. Present during the inspection were 3 staff and 0 clients. At 11:15AM, LPA Karkazis reviewed client and staff files. All staff and client files were complete and in good order. At 1:17PM, LPA Karkazis toured the facility. LPA Karkazis observed 4 bedrooms and 3 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 111 degrees which is in range. The thermostat read 68 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the medications room. The facility is in good repair and clean. LPA Karkazis interviewed 3 staff and no clients. Clients were at school and non verbal. At 1:32PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. Maria Gonsalves stated that the facility will be closing 10/31/2024, and that a closure plan has been submitted to CDSS> An exit interview was conducted, appeal rights discussed and a copy of this report was given to Maria Gonsalves / Facility Manager House Lead.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/01/24 at 10: AM, Licensing Program Analysts (LPAs) Mona Lam and Jonathan Medina conducted an unannounced visit to the licensed facility listed above. The purpose of the visit is to follow up on an appeal for a citation issued on 07/02/2024. LPAs met with Vanessa Baldwin, Administrator. Based on the review of documents obtained and the inspection conducted by LPA Lam, the appeal is granted for citation issued on 07/02/24 regarding a review of documentation pertaining to facility's non-compliance conference (NCC) terms. LPAs informed that a new LIC 500 must be submitted and new information from Regional Center to support the changes of the new staffing hours. The facility would need to meet with CCL to update the NCC's plan prior to the next NCC's visit. Vanessa Baldwin will send availability to LPAs on the behalf of the facility in terms of when the meeting will be held. LPAs conducted a facility tour. LPAs observed sufficient food within the pantry and refrigerator. LPAs observed four bedrooms and three bathrooms. Two nurses and two staff members are currently on shift. One client is currently out at an appointment. An exit interview was conducted, and a copy of this report was given to Vanessa Baldwin whose signature confirms the receipt of this report.

met_with: Vanessa Baldwin


summary: Facility Evaluation

raw_content:
Narrative:
On 10/17/ Licensing Program Managers (LPMs) Helga Wong and Carolyn Flynn as well as Licensing Program Analysts (LPAs) Mona Lam and Jonathan Medina had an office meeting with People's Care Northern California. The staff members present included Chief Operation Officer Michelle Mainez, Regional Director of Northern and Central California Mauricio Villatoro, Administrator Vanessa Baldwin, District Manager of Northern California John O'Brien, and House Lead Maria Gonsalves. The meeting was held to revise the facilities Non-Compliance plan on item number 4 regarding staffing and the operation of the facility. Revision of item number 4; Facility will have enough staff to meet ratio requirement based on current clients' needs and services plan and Regional Center's requirements on individual program plans. John O'Brien and Michelle Mainez informed Community Care Licensing (CCL) that they will surrender the license due to lack of qualified staff in local area. CCL provided information on PIN 18- CRP regarding closure plan. Currently, facility has a plan for the remaining two clients to be placed in other facilities. They are planning to transition the clients out on October 21, 2024 and October 29, 2024. LPA Jonathan Medina will send out LIC 809 to John O'Brien for review and signature.

met_with: John O'Brien - District Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 11/1/24 at 3:30PM Licensing Program Analyst (LPA) Jonathan Medina made an unannounced inspection to the facility for the purpose of ensuring that the facility is not operating. LPA observed the facility to be vacant, furnished, free from debris, and in good repair. LPA inspected the entire outside of the property. LPA observed no persons to be on or within facility property.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 10/12/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility, during which the below deficiencies were found. LPA met with Care Staff Jagprit Singh and over the phone with District Manager Kourtney Hamilton and informed of the purpose of the visit. LPA observed that there are two residents present, and two staff, neither of whom are facility managers. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. Lastly, at least one resident has aged out of the children's residential age range. The facility is licensed for up to age 17, and an age exception can be granted up until the age of 22. Of the four residents in care, currently four are 18 or older, and one is 22. The facility was previously advised of the requirement to ensure an age-appropriate placement for this resident and informed LPA that the delay was on the placing agency's end. LPA is issuing a citation of CCR, Title 22, Section Limitations on Capacity and Ambulatory Status. An exit interview was conducted with District Manager Kourtney Hamilton over the phone, and appeal rights and a copy of this report was sent to District Manager, who agreed to sign and return to LPA as confirmation of receipt.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 Personnel Requirements
(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present

met_with: Care Staff Jagprit Singh; District Manager Kourtney Hamilton


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On 12/9/22 at 1:05PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a case management visit. LPA was granted entry by LVN Anita Wilson and informed of the purpose of the visit. Interim Administrator Kylie LeBlanc arrived around 3PM. During visit, LPA toured the facility site, inspected facility files, observed four residents who are nonverbal, and conducted confidential interviews with 2 staff. LPA received a report from an agency overseeing the facility that the facility had painters on 12/7/22. During LPA's tour, LPA could smell the paint in the bedrooms through LPA's mask but there were not hazardous fumes. Based on interview with Interim Administrator, Interim Administrator is not sure if painters were here but stated that sometimes maintenance workers are sent and no notice given to Interim Administrator. Based on the report, the painters were painting a resident's room while all residents were at the facility, and the materials were accessible to residents, but it was not observed that residents touched any of the materials. Additionally, during LPA's tour today, LPA observed a tub of chemical cleaning wipes in an unlocked kitchen cabinet with a broken drawer above it, exposing the contents of the cabinet. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80087(g) Buildings and Grounds. Prior to Interim Administrator's arrival around 3PM, there were two staff on shift who identified themselves as not facility managers, while there were four residents present. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personnel Requirements. The facility was previously cited for this on 10/12/22. Due to the repeat violation, LPA is assessing a civil penalty of $250. See LIC 421. During visit, LPA observed that there were residents in care who had been planned to be moved to an appropriate adult placement due to aging out. The facility was previously cited on 10/12/22 with a plan to move the residents by 10/31/22. Additionally, based on observation and interview, one resident (See LIC... ... Confidential Names for names and details) is not currently enrolled in an educational school or day program, and there is no activity schedule or plan being followed by care staff or current plan posted in the facility. LPA is issuing citations of California Code of Regulations, Title 22, Section Limitations on Capacity and Ambulatory Status and Section Planned Activities. Due to repeat violation of 80010, LPA is assessing a civil penalty of $250. See LIC 421. LPA observed multiple broken cabinets in the kitchen. Two cabinet doors were missing, and one drawer was missing. Based on interview, the doors and drawer have been missing for at least 5 days. LPA is issuing an advisory of California Code of Regulations, Title 22, Section 80087(a) Buildings and Grounds. An exit interview was conducted, appeal rights provided, and a copy of this report provided to the facility. Interim Administrator Kylie LeBlanc's signature on this form confirms receipt.

Deficiencies:
84065(d): 1
2
3
4
5
6
784065 Personnel Requirements
(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
84079: (4) Educational activities...

met_with: Interim Administrator Kylie LeBlanc

title:
Planned Activities
(a) The licensee shall develop, maintain, and implement a written plan to ensure that indoor and outdoor activities which include...the following are provided for all children

description: (4) Educational activities...


summary: Facility Evaluation

raw_content:
Narrative:
On 1/18/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility to deliver notice of deficiencies observed at the facility and/or during investigation. LPA met with House Manager April Lindsey and Compliance & Training Specialist Erinique Jones and informed of the purpose of the visit. Based on confidential interviews, observation, and record review, a resident sustained multiple injuries, including scratches, bruises, and an injury to the nose, which have not been reported to the licensing agency and for which staff, including management, when interviewed, could not identify the cause of injury nor date of incidence or observation. Additionally, witness statement indicates that the resident's feet were observed in person in December 2022 to be dirty and swollen. Further, record review indicates that multiple injuries and/or observations of injuries were not reported to the authorized representative. LPA is issuing citations of California Code of Regulations (CCR), Title 22, Section 80061(b)(1)(E) and 80061(f) Reporting Requirements. See LIC 809-D (attached). Lastly, during today's visit, LPA observed 20+ cigarette butts on facility grounds. On a prior date, LPA had learned in a confidential witness interview that a staff member was observed smoking across the street. LPA immediately notified District Manager Kourtney Hamilton. LPA is issuing a citation of CCR, Title 22, Section 84087(c) Buildings and Grounds, and advises that even if staff smoke across the street due to the requirement to not smoke on facility grounds, the butts should not be littered, as the dangerous items can be accessible on facility grounds. 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.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 5/26/23, Licensing Program Analyst (LPA) Mariah Hawkins made a case management visit to deliver notice of a deficiency observed during an investigation or inspection at the facility. LPA met with Assistant Administrator Fanesha Caldwell and informed of the purpose of the visit. During a visit to the facility for an investigation, LPA reviewed the resident files and observed the resident's care plans to be missing and requested they be submitted. The next day, the facility submitted needs and services plans dated that day with no detail other than a direction to refer to the attached individualized program plans (IPP), which were not attached for two residents. The IPP that was submitted was dated 2020. The needs and services plan should be updated at least every 6 months. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84068.3. 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.

Deficiencies:
84068.3(a): 1
2
3
4
5
6
784068.3 Modifications...Needs...Services...
(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
On 9/8/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a POC visit to follow up on a plan of correction (POC). LPA met with Interim Administrator Vanessa Baldwin and informed of the purpose of the visit. A POC was developed for a citation of 84065(d) issued on 8/8/23. See LIC Annual/Required dated 8/8/23. The POC was due 8/31/23 and was to designate and train facility managers and submit the LIC 500 reflecting a facility manager (FM) on each shift, which is one of the terms of the March 2023 noncompliance conference. The POC submission was sent on time, but the following items were incomplete or missing: 1) No LIC 500 was submitted; 2) The designation forms, LIC Designation of Facility Responsibility, were submitted but were completed incorrectly and are invalid. There are no names written on the designated staff lines, and the forms are not signed by the licensee designee (i.e. Administrator); 3) The FM training records for four staff were submitted, but the records do not reflect all required training topics, including appeal rights and interaction with law enforcement, neighbors, and family, which are required by the plan of operation and Title 22. LPA discussed the above with Interim Administrator and reviewed the LIC 500, LIC 308s, and training records. LPA observed that the LIC 500 needs to be updated to reflect the current FMs, and the LIC 308s need to be redone. Staff S1, hired in August 2023, is listed as a FM but no FM training was completed since hire at this facility and no documentation was in the file. Lastly, the FM training was confirmed to not include the topics listed above, and no training evaluation was completed. LPA is issuing citations of California Code of Regulations, Title 22, sections 84065(d)(3), 84065(k)(5), and 84065(k)(2)(E)(1). An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Vanessa Baldwin, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/27/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit at the facility. LPA met with Facility Manager Anita Wilson and informed of the purpose of the visit. During the visit, LPA observed that there were two staff working and two residents, who both require 1:1 supervision and support, per their individual service plans. LPA observed the staff be simultaneously responsible for meal preparation, cleaning, and administrative tasks, such as answering multiple phone calls and scheduling over the phone, as well as care and supervision. LPA also observed that the facility did not have a current license posted, which LPA previously provided to the Administrator. Lastly, LPA has advised that an exception request be submitted for the interim administrator to be approved as an administrator, due to them waiting for their administrator certification. However, no exception has been submitted, so the facility is currently out of compliance without a certified administrator nor approved exception. LPA is issuing three citations of California Code of Regulations, Title 22, Sections 84065.2, 84009, and 84064. Additionally, due to repeat violation within 12 months of section 84064(b), LPA is assessing a civil penalty of $250. See attached LIC 421FC. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Anita Wilson, whose signature on this form confirms receipt.


summary: Facility Evaluation - 3 deficiencies

raw_content:
Narrative:
On 12/13/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit and met with Facility Manager Angela Davis. LPA informed that the purpose of the visit was to conduct a quarterly inspection, per the agreed upon terms of the noncompliance conference (NCC). LPA inspected the facility site as well as facility records, including personnel and resident records. LPA observed the facility to be clean and free of safety hazards. LPA observed facility records to be well-organized. LPA observed that staff have valid first aid and CPI certifications and that qualified staff have been hired to provide care to residents. The facility has designated an administrator to oversee only one facility. LPA observed the following deficiencies during the file review: 1) Personnel files do not contain performance evaluations. LPA is issuing a citation of California Code of Regulations (CCR), Title 22, Section Personnel Records. 2) Resident R2's (see LIC Confidential Names dated 12/13/23) file contained a blank preplacement assessment and needs and services plan, a blank/unsigned personal rights form, a blank/unsigned complaint procedures form, and no physician's report or other medical assessment documentation. The resident was admitted more than 30 days ago. LPA is issuing citations of CCR, Title 22, Sections Personal Rights, 84068. Intake Procedures, Client Records, and 84072. Complaint Procedures. A total of 5 deficiency citations were issued at this visit. See LIC 809-D pages. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Facility Manager Angela Davis, whose signature on this form confirms receipt.

Deficiencies:
84066: (6) A record of each work performance evaluation and any correspondence with the employee.
84072(c): 1
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784072 Personal Rights
(c) At admission, each child, and his/her authorized representative, shall be personally advised of and given a copy of the child's rights as specified in Subsection d below
80070: (8) Medical assessment, including ambulatory status, as specified in Section 80069.

title:
Personnel Records
(b) The licensee shall maintain the following personnel records

title:
Client Records
(b) Each record must contain information including, but not limited to, the following


summary: Facility Evaluation

raw_content:
Narrative:
On 2/29/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management inspection to follow-up on submitted incident reports. LPA met with Facility Manager Angela Davis and informed of the purpose of the visit. Per the submitted incident reports, a staff member reported witnessing another staff member engaging with the residents inappropriately by using a raised voice, harsh language or tone, and swatting or hitting at a resident. The staff member was terminated. During a review of the involved staff member's files, LPA obtained staff contact information and staff schedules. LPA also observed that the personnel file for the involved staff (S3 -- See LIC Confidential Names) and facility staff training binders reflected incomplete and unsigned initial training records and only 12.5 hours of training since July 2023, which is less than the 16 hours of training that is required to have been completed by S3 by at least January 2024 (assuming part-time employment). LPA observed the job shadowing portion of the training to be missing indication of the time spent on each activity. Administrator stated over the phone that S3 completed additional training and the initial training, and LPA explained that all training needs to be documented and maintained in personnel records on site. LPA is issuing a citation of California Code of Regulaitons, Title 22, Chapter 5, Section Personnel Requirements. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Angela Davis, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/13/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management inspection to follow-up on an incident report. LPA met with Facility Manager Maria Gonzvales and informed of the purpose of the visit. This visit is a continuation of the case management visit conducted on 2/29/24. See LIC Case Management-Incident dated 2/29/24. Based on confidential interviews, record review, and/or observation, a staff member behaved inappropriately toward the residents by raising their voice and using profanity at resident(s) in care. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personal Rights. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Facility Manager Maria Gonzvales, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/13/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit in order to deliver notice of deficiencies found during the course of an investigation or inspection at the facility. LPA met with Facility Manager Maria Gonzvales and informed of the purpose of the visit. On multiple dates since December 2023, the facility has not followed the required staff to resident ratios. Staff statements and record review indicate that on multiple occassions, a staff member has worked as the only staff on site with four residents present, including two residents (R1 and R2) who both require one to one supervision per their care plans. LPA observed that the health care plan for R1 has not been updated within 6 months, as it is dated April 2023. LPA reviewed the other care plans in the record and observed that the health care plan has not been combined with another care plan. LPA observed that seizure activity was noted in the shift notes on 2/3/24 for R1 but was not logged in the seizure log, as required by the resident's care plan. Additionally, nurse shift notes indicate that there was no nurse working on 2/3/ PM when the seizure occurred nor 2/4/ AM. The LIC 500 provided to LPA on 2/8/24 reflects that only one staff is scheduled to work from 6AM to 7AM, no staff is scheduled to work on Mondays from 6AM to 7AM, only one staff is scheduled to work on Mondays from 7AM to 9AM, no administrator or manager is scheduled to work on Tuesdays, Wednesdays, and Thursdays from 6AM to 9AM nor on Fridays from 6AM to 2PM. Staff statements do not confirm that these shifts were in fact uncovered. LPA is issuing a citation of California Code of Regulations, Title 22, Section Responsibility for Providing Care and Supervision and Section 84069. Individualized Health Care Plans for Specialized Group Homes. LPA also advises ensuring the LIC 500 reflects appropriate coverage for all hours. An exit interview was conducted, appeal rights provided, and a copy of this report left with Facility Manager Maria Gonzvales, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 7/2/2024 at 11:05am, Licensing Program Analyst (LPA) Selena Hood and LPA Mona Lam conducted an unannounced visit to the licensed facility. LPAs met with Vanessa Baldwin, Administrator. During this visit, LPAs found that one client had a seizure on 6/23/2024 based on a written seizure log. Based on record review and confidential interview, the facility had not submitted an incident report for this seizure. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type B citation for California Code of Regulations, Title 22, 800619(b)(1)(E) Reporting Requirements. Based on record review, two clients in care had not received updated Needs and Services Plans since February 2023. This poses a potential risk to to the health, safety, and or personal rights of clients in care. LPAs delivered a Type B citation for California Code of Regulations, Title 22, 84068.3(a) Modifications to Needs and Services Plans. During the inspection, LPA Hood observed that there was a dresser drawer in one client's rooms that was broken. Facility staff was able to remove and fix the dresser drawer while LPAs were present. LPAs conducted an exit interview and delivered appeal rights to Vanessa Baldwin, Administrator, and Maria Gonsalves, Facility Manager, at 2:52pm whose signature confirms the receipt of this document.

Deficiencies:
84068.3(a): 1
2
3
4
5
6
784068.3(a)Modifications...Needs...Services...
(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


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

met_with: Rodina Ventura