107206798-5-8-2023-24-AS-SPIY-CRWQMQ-20230517121751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 107206798
Report Date: 05/08/2023
Date Signed: 05/08/2023 11:28:48 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2023 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20230131110155

FACILITY NAME:	ASPEN RESIDENTIAL CARE HOMES INC II		FACILITY NUMBER:	107206798
ADMINISTRATOR:	YARBROUGH, SHELLY		FACILITY TYPE:	740
ADDRESS:	3107 W GETTYSBURG AVE		TELEPHONE:	(559) 492-2026
CITY:	FRESNO	STATE: CA	ZIP CODE:	93722
CAPACITY:	6	CENSUS: 5	DATE:	05/08/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Shelly Yarbrough		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff do not ensure privacy while providing personal care
Staff do not ensure sanitary conditions when assisting resident with personal care
Staff speak inappropriately to residents
Staff are not assisting resident with shower as scheduled

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct a subsequent complaint visit and deliver the investigation findings to the facility. LPA met with and explained the purpose of the visit with Administrator (AD) Shelly Yarbrough.

Staff members interviewed state that R1 is assisted with catheter care in the facility restroom or R1’s bedroom to ensure privacy. Record review of R1’s Restricted Condition Health Care Plan reveals that staff have been trained to ensure privacy during catheter care.

Staff interviews were conducted and reveal that staff have been trained how to assist R1 with catheter care in a safe and sanitary manner. Record review of R1’s Restricted Condition Health Care Plan reveals that staff have been trained to ensure sanitary conditions during catheter care.

See LIC9099C for continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20230131110155

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ASPEN RESIDENTIAL CARE HOMES INC II	FACILITY NUMBER: 107206798
	VISIT DATE: 05/08/2023

NARRATIVE

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Staff members interviewed state that R2 has extreme emotional outbursts and can display “obsessive” behaviors desiring all of staff’s attention. Interviews reveal that staff have been trained with techniques about how to de-escalate and redirect R5. Record review reveals that these behaviors are noted in R2’s IPP.

Staff members were interviewed and state that R3 received assistance with showers daily. Resident showers are documented on the facility Daily Care Collections Sheet. Record review was conducted of R3’s sheet for January 2023.

Based on interviews and record reviews, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur.

There were no citations issued

An exit interview was conducted and a copy of this report was left with AD, whose signature confirms receipt of these documents.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/08/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2023

LIC9099 (FAS) - (06/04)

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