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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208893
Report Date: 05/11/2024
Date Signed: 05/11/2024 04:02:47 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
05/06/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20240506163301
FACILITY NAME:SAILS VIIFACILITY NUMBER:
157208893
ADMINISTRATOR:MARQUEZ, JOSEFACILITY TYPE:
735
ADDRESS:4013 REDFORD CTTELEPHONE:
(661) 473-2339
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY:4CENSUS: 4DATE:
05/11/2024
UNANNOUNCEDTIME BEGAN:
08:17 AM
MET WITH:District Manager Ty SchererTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Staff physically abuse client
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. LPA identified herself and explained the purpose of the visit and the elements of the allegations LPA met with District Manager Ty Scherer. LPA delivered findings.

LPA interviewed staff and clients. LPA requested copies of staff files. LPA obtained a copy of the facility's internal investigation. LPA requested copy of photo showing injury and medical report. LPA took a photo of C2's injury. LPA requested copies of C1's IPP and C2's file. LPA requested copies of LIC500 and staff schedule.

Based on the Departments interviews and photo, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D. Civil Penalty was issued.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2024
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 3
Control Number 24-AS-20240506163301
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 VII
FACILITY NUMBER: 157208893
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/13/2024
Section Cited
CCR
80072(a)(3)
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80072 Personal Rights (a) ....., each client shall have personal rights which include, but are not limited to, the following: (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, including but not limited to: interference with the daily living functions, including eating, sleeping, or toileting; or withholding of shelter, clothing, medication or aids to physical functioning.
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Plan of Correction POC Licensee agrees to conduct training for abuse, mandated reporting ect. Licensee submitted training during visit. Civil Penalty was issued.

POC cleared
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This requirement was not met as evidenced by Licensee did not keep C2 free from cprporal or unusual punishment which poses an immediate health safety and or personal right risk to clients 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.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20240506163301
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 VII
FACILITY NUMBER: 157208893
VISIT DATE: 05/11/2024
NARRATIVE
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An immediate Civil Penalty is being assessed. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report, if any.

The Department found additional deficiencies during the course of the investigation, which will be addressed and cited on a separate 809 and 809D.

An exit interview was conducted, a copy of this report, plans of correction, and appeal rights were provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 05/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3