157209299-1-31-2024-24-AS-SMOA-D2FN2F-20240214090437

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209299
Report Date: 01/31/2024
Date Signed: 01/31/2024 11:32:56 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
01/22/2024 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240122102719

FACILITY NAME:	LERWICK HOME CARE		FACILITY NUMBER:	157209299
ADMINISTRATOR:	TELMO, SOCORRO ANN		FACILITY TYPE:	740
ADDRESS:	10213 LERWICK AVENUE		TELEPHONE:	(661) 665-2874
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 5	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	11:02 AM
MET WITH:	Administrator Socorro Ann Telmo		TIME COMPLETED:	11:35 AM

ALLEGATION(S):

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Facility staff financially abused resident

INVESTIGATION FINDINGS:

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On 01/31/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Socorro Ann Telmo.

During the course of the investigation, the Department conducted interviews and reviewed records. Administrator had stated the Administrator had Resident 1(R1)’s debit card and check book. Administrator admitted to the department, the Administrator had been using the resident’s debit card to make multiple withdrawals and had wrote checks out from the resident’s bank account. Based on records reviewed and interviews conducted, 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, is being cited on the attached Lic 9099D. An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator, whose signature confirms receipt of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20240122102719

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: LERWICK HOME CARE	FACILITY NUMBER: 157209299
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/31/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/01/2024 Section Cited HSC 1569.50(a)(4)	1 2 3 4 5 6 7	HSC 1569.50(a)(4) Conduct that is inimical to the health, morals, welfare, or safety of either an individual in or receiving services from the facility or the people of the State of California. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee is to return R1’s checks and debit card to the resident or responsible party/family and reimburse the resident for the money spent and withdraw by the POC due date. Confirmation of checks, debit card, and money reimbursement given back to the resident/ responsible party shall be submitted to Fresno CCL office by POC due date 02/01/24.
	8 9 10 11 12 13 14	Based on records reviewed and interviews conducted, Administrator admitted to writing checks from a resident’s personal account, keeping the resident’s debit card, and making withdrawals from the resident’s account, which poses an immediate Health, Safety, and Personal Rights risk to the resident.	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: See Moua	TELEPHONE: (559) -65-7912
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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