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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206771
Report Date: 10/03/2023
Date Signed: 10/03/2023 03:20:36 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
09/27/2023 and conducted by Evaluator Melinda Medina
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230927121508
FACILITY NAME:SAILS APPLETREEFACILITY NUMBER:
157206771
ADMINISTRATOR:JACQUELINE D. TUCKERFACILITY TYPE:
735
ADDRESS:11611 SAN MINIATO AVETELEPHONE:
(661) 570-3035
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:5CENSUS: 4DATE:
10/03/2023
UNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Jacqueline TuckerTIME COMPLETED:
03:41 PM
ALLEGATION(S):
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Staff denied client entry into facility
INVESTIGATION FINDINGS:
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On 10/03/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced initial 10-day complaint visit. LPA introduced self, stated purpose of visit, and allowed entrance by staff. Administrator contacted by telephone and arrived a short time later to conduct visit.

This department investigated the above allegation. During the course of the investigation, interviews were conducted and reviewed records.

Based on the interviews conducted, the preponderance of evidence standard has been met, therefore the allegation: Staff denied client entry into facility is found to be SUBSTANTIATED.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 9099D.

Exit interview was conducted and a plan of correction developed and reviewed. A copy of this report provided to Administrator for facility records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
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 2
Control Number 24-AS-20230927121508
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: SAILS APPLETREE
FACILITY NUMBER: 157206771
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/13/2023
Section Cited
CCR
80072(a)(1)
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(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (1) To be accorded dignity in his/her personal relationships with staff and other
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Administrator to conduct inservice training with staff and will submit sign in sheets and agenda to Fresno Regional Office no later than POC due date.
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persons.
***This was not met as evidenced by S1 denied R1 entry into facility to obtain their personal belongings before going to program.
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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.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 10/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/03/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2