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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 045002459
Report Date: 05/17/2022
Date Signed: 05/17/2022 03:44:38 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/15/2021 and conducted by Evaluator Misty Valencia
COMPLAINT CONTROL NUMBER: 25-AS-20211115101114
FACILITY NAME:OMIA GUEST HOMEFACILITY NUMBER:
045002459
ADMINISTRATOR:ANGELITA MARTINEZFACILITY TYPE:
735
ADDRESS:2130 FOGG AVENUETELEPHONE:
(530) 534-7060
CITY:OROVILLESTATE: CAZIP CODE:
95965
CAPACITY:6CENSUS: 4DATE:
05/17/2022
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Bella Baguhin, Direct Care staffTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Personal Rights-invading client's privacy
Personal Rights-locking a client out of the facility
Neglect/Lack of care and Supervision-client's overdose on drugs
Neglect/Lake of care and Supervision-staff are verbally Abusive to clients
INVESTIGATION FINDINGS:
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On 05/17/2022, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegations and met with Bella Baguhin, Direct Care staff. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened by Bella Baguhin, Direct Care staff.


continued on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20211115101114
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: OMIA GUEST HOME
FACILITY NUMBER: 045002459
VISIT DATE: 05/17/2022
NARRATIVE
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  • Staff invading client's privacy
  • Staff locking a clients out of the facility
  • Client overdose on drugs
  • Staff Verbal Abuse Clients

During interviews with Administrator, staff, residents, and records reviewed it was determined that the allegations above to be un-substantiated. Interviews concluded that the clients all have their own rooms and that staff knock before entering. The door is locked for safety reasons, but staff always opens it when the clients knock to come home. A client has overdosed, but the drugs were not from facility. Client over a year ago overdosed, but was immediately taken to the hospital for care. All staff and clients interviewed reported that they have never witnessed or heard any staff being verbally abusive to residents in care. The preponderance of evidence standard has not been met. The allegations are un-substantiated

The preponderance of evidence standard has not been met. The allegations are Unsubstantiated.



Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2