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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202532
Report Date: 05/10/2024
Date Signed: 05/14/2024 06:58:03 AM

Document Has Been Signed on 05/14/2024 06:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KERN TRANSITION HOME-RIVER GLENFACILITY NUMBER:
157202532
ADMINISTRATOR/
DIRECTOR:		WILLIAMS, DONTEFACILITY TYPE:
735
ADDRESS:4409 RIVER GLEN DRIVETELEPHONE:
(661) 213-3800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
05/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:49 PM
MET WITH:Brandy Frazier, Program Director
Donte Williams, Area Director		TIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 05/10/2024, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management visit based on a recent file review. LPA was greeted by facility supervisor, stated the purpose of the visit and was allowed entry
into the facility. PS called Program Director (PD) who arrived a short time later. Administrator/Area Director also arrived to the facility. During a recent file review, LPA reviewed incident reports for the facility and observed the following.

10/17/23 - report received alleging Staff S1 and Staff S1 had been employing door stoppers to help mitigate behavioral challenges in 2 out of the 4 residents in care. Licensee conducted an internal investigation with findings of unsubstantiated and additional personal rights training was conducted for all staff.

10/21/23 - Resident R1 AWOL'd from the facility and was shadowed. Staff did not lose sight of R1. Program Director (PD) has obtained 1:1 (24 hour) staffing for Resident R1. LPA obtained copy of facility's elopement protocol that includes a 15 minute bed check daily log that is signed by staff on shift. There has been no AWOL incidents reported since this date.

Administrator for facilty is listed as Donte Williams, however, records review and interviews show Administrator is and has not been present in the facility on a daily or weekly basis. Administrator is the Area Director and oversees multiple facilities. Program Director who oversees the facility does not have an Administrator's certificate.

LPA reviewed Needs and service plans for 2 out of 4 residents in care. 4 out of 4 Resident's in care lack hazard awareness/ impulse control and/or may pose a danger to themselves or others. LPA requested facility's Emergency Intervention plan and proof of staff training. There is no plan or training on file.

(Continued on 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/10/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/14/2024 06:58 AM - It Cannot Be Edited


Created By: Lisa Salazar On 05/10/2024 at 01:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2024
Section Cited
CCR
86504(e)

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85064 Adminstrator Qualifications and Duties
(e) The administrator shall be on the premises the number of hours necessary to manage and administer the facility in compliance with applicable law and regulation. This requirement was not met as evidenced by LPA's records review of staff schedule and interviews with staff, Administrator is not present in the facility on a daily or weekly basis. Administrator is the Area Director and oversees other homes.
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Licensee will appoint a new Administrator or provide documentation that Program Director has completed required course and paid fees to obtain an Administrator's certificate.
Type B
05/31/2024
Section Cited
CCR
85122(a)(1)

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85122 Emergency Intervention Plan
(a) The applicant or licensee shall be responsible to ensure an Emergency Intervention Plan is developed and approved by the Department prior to the use of manual restraint or seclusion, if staff use or it is reasonably foreseeable that staff will use these techniques. (1) The Emergency Intervention Plan shall be designed and approved by the applicant or licensee in conjunction with a Behavior Management Consultant and shall be part of the Plan of Operation.
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Licensee will submit an emergency intervention plan by POC date. The plan shall include person-centered problem solving strategies that diffuse and safely resolve emerging crisis situations and strategies...
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This requirement was not met as evidenced by LPA records review of facility incident reports and resident's needs and service plans. 2 out of 4 residents in care require 1:1 supervision.
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Type B
05/31/2024
Section Cited
CCR
85165(d)(1)

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85165 Emergency Intervention Staff Training
(d) The emergency intervention training curriculum shall address, at a minimum, the following: (1) Techniques of group and individual behavior management, including, but not limited to, crisis prevention and intervention, positive behavioral supports, and precipitating factors leading to assaultive behavior.This requirement was not met as evidenced by LPA request for the facility's emergency intervention plan. 4 out of 4 Resident's in care lack hazard awareness/ impulse control and/or may pose a danger to themselves or others.

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Licensee will send proof of staff emergency intervention training by POC date. Instructional curriculum will be provided to facility personnel regarding the techniques that may be used to prevent injury to, and maintain safety for, clients who are a danger to themselves or others, and shall emphasize positive behavioral supports and techniques...
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 05/14/2024 06:58 AM - It Cannot Be Edited


Created By: Lisa Salazar On 05/10/2024 at 03:11 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2024
Section Cited
CCR
80066(e)(1)

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(e) All personnel records shall be maintained at the facility site and shall be available to the licensing agency for review. (1) The licensee shall be permitted to retain such records in a central administrative location provided that they are readily available to the licensing agency at the facility site as specified in Section 80066(c).
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Licensee will provide copies of required personnel documentation listed in Title 22 80065(a) (1-9), for 5 staff by POC date of 05/31/2024
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This requirement was not met as evidenced by LPAs request for staff records. Program Director did not have access to 5 out of the 8 personnel records requested.
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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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532
VISIT DATE: 05/10/2024
NARRATIVE
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(Continued from LIC 809)

Per California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited on the attached 809-D. If not corrected, this poses a potential risk to the health safety and personal rights to residents in care.

An exit interview was conducted with Administrator and Program Director. A copy of this report and appeal rights were provided via email 05/13/24.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC809 (FAS) - (06/04)
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