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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201018
Report Date: 12/29/2022
Date Signed: 12/29/2022 12:55:32 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/17/2022 and conducted by Evaluator Laura Hall
COMPLAINT CONTROL NUMBER: 15-AS-20221117164942
FACILITY NAME:TELECARE HILLSIDE HOUSEFACILITY NUMBER:
079201018
ADMINISTRATOR:STACI L. STEVENSFACILITY TYPE:
737
ADDRESS:205 HILLSIDE ROADTELEPHONE:
(925) 433-0577
CITY:ANTIOCHSTATE: CAZIP CODE:
94509
CAPACITY:4CENSUS: 4DATE:
12/29/2022
UNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Mary Thrower, Vice President of OperationsTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Staff does not follow resident's behavior support plan.

Staff stole from resident.

Staff does not treat resident with dignity.
INVESTIGATION FINDINGS:
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On 12/29/2022 at 11:20AM, Licensing Program Analysts (LPAs), L. Hall and L. Alexander arrived unannounced to deliver complaint findings for the allegations above. LPA met with Mary Thrower, Vice President of Operations and explained the reason for the visit.

During the investigation LPA interviewed staff, Anonymous Reporting Party, reviewed and collected documents. During interview with the Anonymous Reporting Party it was stated that it was told that staff stole from resident. The Anonymous Reporting Party did not witness any theft and was not able to give names of staff that had possibly stolen from C1. During the interviews with Staff no one stated that any property was stolen or held from C1.

Continued on LIC809C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
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 15-AS-20221117164942
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: TELECARE HILLSIDE HOUSE
FACILITY NUMBER: 079201018
VISIT DATE: 12/29/2022
NARRATIVE
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Continued from LIC809.

On the allegation Staff does not treat resident with dignity. During interviews S3 stated she witnessed a Staff snatch the covers off C1 to wake him up. S7 stated that she heard that a Staff member degraded a client but did not witness the action. The other Staff members that were interviewed stated that all the clients are treated with dignity and have not observed any staff degrade the clients. S1 stated that there have not been any complaints from staff or clients regarding abuse or dignity not being given.

On the allegation Staff does not follow resident’s behavior support plan. LPA reviewed C1’s Individual Behavior Support Plan (IBSP) to confirm what is required of Staff. During interview S7 stated that Staff would say things to trigger C1 into a behavior and withhold C1’s property to get him to comply. S3 stated staff have been seen antagonizing clients to make the clients go into behaviors. The other Staff members stated the IBSP is followed for the clients and the Staff works as a team to make that happen.

Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

Exit interview conducted and a copy of this report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Laura Hall
LICENSING EVALUATOR SIGNATURE:

DATE: 12/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2