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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206793
Report Date: 05/07/2021
Date Signed: 05/10/2021 08:25:55 AM

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
02/01/2021 and conducted by Evaluator Darius Williams
COMPLAINT CONTROL NUMBER: 24-AS-20210201091316
FACILITY NAME:UNITED IN THE WESTFACILITY NUMBER:
157206793
ADMINISTRATOR:SHENA OWENSFACILITY TYPE:
735
ADDRESS:8101 FALLS CTTELEPHONE:
(661) 588-0636
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:4CENSUS: 4DATE:
05/07/2021
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator, Daniel EsparzaTIME COMPLETED:
10:35 AM
ALLEGATION(S):
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Staff caused injury to resident.
Staff used inappropriate discipline on resident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced complaint visit, via telephone, due to Covid-19 precautionary measures. LPA Williams spoke with Administrator Daniel Esparza and described the purpose of the visit; to deliver complaint findings.

The Department has investigated the above allegations via staff interviews, collateral interviews, and facility records review.

With regards to the allegation staff caused injury to resident, the Department discovered Staff 1 caused injury to Resident 1’s (R1) right arm, resulting in a bruise and small cut.

With regards to the allegation staff used inappropriate discipline on resident, Staff 2 admitted to pouring R1’s coffee down a sink, as a form of discipline.

*Continued on LIC 9099-C.*
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
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 3
Control Number 24-AS-20210201091316
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: UNITED IN THE WEST
FACILITY NUMBER: 157206793
VISIT DATE: 05/07/2021
NARRATIVE
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Based on interviews and records review the preponderance of the evidence standard has been met,
therefore, the above allegations are found to be SUBSTANTIATED. California Code Regulation, Title 22, Division 6, Chapter 1, Section 80072(a)(3), is being cited on the attached LIC 9099-D.

The plan of correction was reviewed with the Administrator.

An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20210201091316
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: UNITED IN THE WEST
FACILITY NUMBER: 157206793
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/08/2021
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights; (a) ...each client shall have personal rights which include...; (3) To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, ...

This requirement was not met evidenced by:
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Licensee terminated Staff 1 and Staff 2 from the facility.

The Administrator has agreed to schedule a Personal Rights staff training to be completed by 5/14/2021.

The Administrator shall submit a letter to the
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Based on interviews and record review, the Licensee did not ensure Resident 1 was free from the infliction of pain and unusual punishment, which poses an immediate health and safety risk to persons in care.
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Department by POC due date of 5/8/2021, acknowledging the Personal Rights training will be completed and submission of training roster to the Department by 5:00 p.m. on 5/14/2021.
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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: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3