157206922-8-13-2024-24-AS-SPIY-D8MSRH-20240830140623

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157206922
Report Date: 08/13/2024
Date Signed: 08/13/2024 02:35:26 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
06/17/2024 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240617104706

FACILITY NAME:	ARCADIA FAMILY CARE III		FACILITY NUMBER:	157206922
ADMINISTRATOR:	YATCO, JASMINE		FACILITY TYPE:	740
ADDRESS:	10615 TROPHY CT		TELEPHONE:	(661) 588-1483
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	6	CENSUS: 5	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	12:21 PM
MET WITH:	Jasmine Yatco		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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9

Staff allow more than two residents to share a bedroom

INVESTIGATION FINDINGS:

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13

On 8/13/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit and allowed entrance by caregiver. Administrator contacted by telephone and arrived a short time later to meet with LPA regarding complaint findings.

This Department investigated the above allegation of staff allow more than two residents to share a bedroom. During facility tour on 6/29/24, LPA observed three beds in the master bedroom. Through information gathered during interviews, LPA was informed that there were previously 3 residents in the room, however one had recently moved out.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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

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
06/17/2024 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240617104706

FACILITY NAME:	ARCADIA FAMILY CARE III		FACILITY NUMBER:	157206922
ADMINISTRATOR:	YATCO, JASMINE		FACILITY TYPE:	740
ADDRESS:	10615 TROPHY CT		TELEPHONE:	(661) 588-1483
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	6	CENSUS: 5	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	12:21 PM
MET WITH:	Jasmine Yatco		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
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9

Staff do not meet residents toileting needs
Staff speak inappropriately towards the residents
Staff do not provide adequate food service
Staff mishandle the residents medications
Staff leave the residents unattended
Staff are unable to communicate effectively

INVESTIGATION FINDINGS:

1
2
3
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5
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7
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9
10
11
12
13

On 8/13/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit and allowed entrance by caregiver. Administrator contacted by telephone and arrived a short time later to meet with LPA regarding complaint findings.

During course of the investigation, LPA toured facility, reviewed records, and conducted interviews. This department had insufficient information regarding the allegations listed above. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or disprove that the allegations occurred therefore the allegations are UNSUBSTANTIATED.

No deficiencies issued during this complaint visit . Exit interview conducted. A copy of this report was provided to Administrator for facility records

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 24-AS-20240617104706

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: ARCADIA FAMILY CARE III	FACILITY NUMBER: 157206922
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/13/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/13/2024 Section Cited CCR 87307(2)(D)	1 2 3 4 5 6 7	Personal Accomodations and Services (2) Resident bedrooms shall be provided which meet, at a minimum, the following requirements: (D) Not more than two residents shall sleep in a bedroom **This was not met as evidenced by, during initial facility visit on 6/29/24, LPA	1 2 3 4 5 6 7	During subsequent visit it was observed that there are now 2 beds in master bedroom. DEFICIENCY CLEARED AT TIME OF COMPLAINT VISIT.
	8 9 10 11 12 13 14	observed 3 resident beds in the master bedroom.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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
06/17/2024 and conducted by Evaluator Melinda Medina

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240617104706

FACILITY NAME:	ARCADIA FAMILY CARE III		FACILITY NUMBER:	157206922
ADMINISTRATOR:	YATCO, JASMINE		FACILITY TYPE:	740
ADDRESS:	10615 TROPHY CT		TELEPHONE:	(661) 588-1483
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	6	CENSUS: 5	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	12:21 PM
MET WITH:	Jasmine Yatco		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not have planned activities for the residents
Staff force a resident to sleep

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 8/13/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced subsequent complaint visit to deliver findings. LPA introduced self and stated purpose of visit and allowed entrance by caregiver. Administrator contacted by telephone and arrived a short time later to meet with LPA regarding complaint findings.

This Department investigated the allegations of staff do not have planned activities for the residents and staff force a resident to sleep. Per information gathered during interviews, LPA was informed and confirmed that facility has an activity cordinator who visits facility three times per week to conduct activities with residents as well as staff organized activities. Also, responsible party for R2 informed department that the rest period of R2 is per family request due to R2's health diagnosis.

This Department has found that the above allegations are UNFOUNDED, meaning they were false, could not have happened, and/or were without reasonable basis. We have therefore dismissed the complaint.

No deficiencies cited.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda Medina	TELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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

LIC9099 (FAS) - (06/04)

Page: 4 of 4