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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 079201094
Report Date: 05/09/2023
Date Signed: 05/09/2023 01:32:23 PM

Substantiated


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
02/24/2023 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20230224125013
FACILITY NAME:WORKING WONDERSFACILITY NUMBER:
079201094
ADMINISTRATOR:SCHWAB, CHRISTINEFACILITY TYPE:
775
ADDRESS:150 MIDDLEFIELD CT SUITE FTELEPHONE:
(925) 331-7797
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:24CENSUS: 13DATE:
05/09/2023
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Christine Schwab , Program director/AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Licensee failed to supervise clients during field trip outing
Staff pushed client
INVESTIGATION FINDINGS:
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On 5/9/2023 at around 10:10AM, Licensing Program Analyst (LPA) L Ibo arrived unannounced to conduct an unannounced complaint visit and deliver the investigation finding. LPA explained the purpose of the visit with staff (S3), LPA called Administrator Christine Schwab to informed her the purpose of the visit. When LPA arrived at the facility, it was observed that there were one staff (S3) with two clients, S3 stated that the other clients went out on an outing. At around 11:30AM, LPA observed clients arrived from outing.

Allegation: Licensee failed to supervise clients during field trip outing

Based on interview and records review, Administrator admitted that there was an incident where one of the clients (C14) was left unattended during a field trip outing. Based on interview and records review, C14 did not sustained any injury regarding the incident mentioned above.

Continue to LIC9099C...

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
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 5
Control Number 15-AS-20230224125013
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: WORKING WONDERS
FACILITY NUMBER: 079201094
VISIT DATE: 05/09/2023
NARRATIVE
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Allegation: Staff pushed client

During the course of investigation, LPA conducted staff and client’s interview. C1 stated that one of the facility staff (S2) had an incident where staff (S2) pushed client (C1). C1 stated that there was no injury during this incident. Records review revealed the incident happened last February 24, 2023.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 15-AS-20230224125013
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: WORKING WONDERS
FACILITY NUMBER: 079201094
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/09/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2023
Section Cited
CCR
82078(a)
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82078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement.

This requirement was not met as evidence by:

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Adminsitrator stated that they implemented a new system where the staff conduct roll call for all clients before they leave the outing location.
Clients and staff was retrained regarding the incident.
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Based on interview, licensee failed to provide supervision to one of the facility clients which poses an potential health and safety risk to the clients in care.
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Adminsitrator agreed to conduct an in-service training for all staff. Facility will submit staff sign in sheet and a copy of facility check procedure to CCLD by POC date
Type B
05/19/2023
Section Cited
CCR
82072(a)(2)
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Personal Rights (a) Each client shall have personal rights which include, but are not limited to, the following: (2)To be accorded safe, healthful...
This requirement was not met as evidence by:


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Administrator/program director has agreed to provide an in-service training for all staff regarding the regulation cited.
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Based on interview and records review, licensee failed to ensure the safety of one client (C1), where one staff S2 pushed C1, which poses a potential health and safety risk to the clients in care.

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Facility will submit a copy of training, name of all staff that will attend the training with their signature. These documents needed to be submitted to CCL by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
02/24/2023 and conducted by Evaluator Leslie Ibo
COMPLAINT CONTROL NUMBER: 15-AS-20230224125013

FACILITY NAME:WORKING WONDERSFACILITY NUMBER:
079201094
ADMINISTRATOR:SCHWAB, CHRISTINEFACILITY TYPE:
775
ADDRESS:150 MIDDLEFIELD CT SUITE FTELEPHONE:
(925) 331-7797
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:24CENSUS: DATE:
05/09/2023
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Christine Schwab , Program director/AdministratorTIME COMPLETED:
12:35 PM
ALLEGATION(S):
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Day program is not kept at a comfortable temperature
Staff does not allow clients to drink water upstairs
Untrained staff
Staff is not providing a safe environment for client
INVESTIGATION FINDINGS:
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On 5/9/2023 at around 10:10AM, Licensing Program Analyst (LPA) L Ibo arrived unannounced to conduct an unannounced complaint visit and deliver the investigation finding. LPA explained the purpose of the visit with staff (S3), LPA called Program Director /Administrator Christine Schwab to informed her the purpose of the visit. When LPA arrived at the facility, it was observed that there were one staff (S3) with two clients, S3 stated that the other clients went out on an outing. At around 11:30AM, LPA observed clients arrived from outing.

Allegation: Day program is not kept at a comfortable temperature

Based on LPA’s observation on visit date 2/28/2023, the first-floor temperature was colder than the second-floor level of the facility, however, there is no thermostat to verify the temperature. On 2/28/2023 LPA observed second floor level’s temperature was set for 73 degrees Fahrenheit. LPA observed a small heater that was set up at the first-floor level.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 15-AS-20230224125013
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: WORKING WONDERS
FACILITY NUMBER: 079201094
VISIT DATE: 05/09/2023
NARRATIVE
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Based on staff interview, staff stated they are aware of the colder temperature at the first-floor level, however they also stated that staff are used to cold temperature on the area. Based on client’s interview, they are comfortable conducting activities at the first-floor level and stated they have no complaint.

Allegation: Personal rights: Staff does not allow clients to drink water upstairs

During the course of investigation, LPA conducted staff interview and clients’ interview; clients stated that they can bring water upstairs (exercise room or yoga room), staff denied not allowing clients to bring water at the exercise room.

Allegation: Untrained staff

Based on records review and staff interview, Administrator conducted several staff training for all the staff.

Allegation: Staff is not providing a safe environment for client

Based on interview with clients in care; the clients stated that they like the facility, they feel safe and comfortable attending the facility program.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.



Exit interview conducted. A copy of this report provided
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE:

DATE: 05/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5