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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107206798
Report Date: 02/03/2023
Date Signed: 02/03/2023 12:37:01 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, 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 IIFACILITY NUMBER:
107206798
ADMINISTRATOR:YARBROUGH, SHELLYFACILITY TYPE:
740
ADDRESS:3107 W GETTYSBURG AVETELEPHONE:
(559) 492-2026
CITY:FRESNOSTATE: CAZIP CODE:
93722
CAPACITY:6CENSUS: 6DATE:
02/03/2023
UNANNOUNCEDTIME BEGAN:
09:08 AM
MET WITH:Shelly YarbroughTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are working without criminal background clearance
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct the initial 10-Day complaint visit. LPA met and explained the elements of the allegations with Administrator (AD) Shelly Yarbrough.

During the visit, LPA conducted record review and interviewed AD. Based on record review and interview, LPA confirmed that Staff (S1) worked at the facility without Criminal Background Clearance. On 1/30/23 S1 was removed from the facility by AD. During the visit, LPA observed S2 was present at the facility without proper clearance. S2 was removed from the facility and cannot return to the facility until a fingerprint clearance is obtained. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D. A Civil penalty in the amount of $500 is being assessed.

See 9099C for continuation of this report
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
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 4
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: 02/03/2023
NARRATIVE
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An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Shelly Yarbrough, whose signature on this form confirms receipt of these documents.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/03/2023
Section Cited
CCR
87355(e)
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87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by:
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S1 was removed from the facility on 1/30/23. S2 was removed from the facility 2/3/23. S1 and S2 will not return to the facility until proper clearance is obtained. Defociency cleared during this visit.
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Licensee did not ensure that S1 and S2 obtained a Criminal Background Clearance prior to working at the facility.

This poses an immediate Health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:

DATE: 02/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4