157209319-8-17-2023-24-AS-SPIY-CUXMEL-20230822093255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209319
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:19:54 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
08/16/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230816084656

FACILITY NAME:	CENTER STREET BOARD AND CARE 2		FACILITY NUMBER:	157209319
ADMINISTRATOR:	BARBATO, ANTHONY		FACILITY TYPE:	735
ADDRESS:	2451 CENTER ST		TELEPHONE:	(415) 810-0145
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY:	18	CENSUS: 18	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Steven Cruz		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
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7
8
9

Staff shared resident's confidential information in front of other residents

INVESTIGATION FINDINGS:

1
2
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5
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7
8
9
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12
13

Licensing Program Analyst (LPA) Shawna Doucette conducted a visit to commence a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Steven Cruz.

LPA interviewed Administrator, Staff and residents. LPA obtained a copy of R1's file. Staff presented a needs in service plan to R1 in a shared room not giving R1 a private space for discussion.

Based on record review and interviews, 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.

An exit interview was conducted with Administrator Steven Cruz and a copy of this report along with appeal rights and plan of correction were provided.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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 3

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
08/16/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230816084656

FACILITY NAME:	CENTER STREET BOARD AND CARE 2		FACILITY NUMBER:	157209319
ADMINISTRATOR:	BARBATO, ANTHONY		FACILITY TYPE:	735
ADDRESS:	2451 CENTER ST		TELEPHONE:	(415) 810-0145
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY:	18	CENSUS: 18	DATE:	08/17/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Administrator Steven Cruz		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not stop resident from going into other resident's rooms

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Shawna Doucette conducted a visit to commence a complaint investigation. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Steven Cruz.

LPA interviewed staff and residents. Facility is in the process of putting locks on residents doors. Facility staff are redirecting R2 when R2 wanders into others rooms.

Although R2 wanders into residents rooms facility staff are redirecting R2 and are in the process of obtaining locks for all resident rooms. It is not determined whether or not Staff do not stop resident from going into other resident's rooms. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
A copy of this report was provided to Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 24-AS-20230816084656

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: CENTER STREET BOARD AND CARE 2	FACILITY NUMBER: 157209319
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/25/2023 Section Cited CCR 80072(d)	1 2 3 4 5 6 7	80072 Personal Rights (d) The licensee shall ensure that each client is accorded the personal rights as specified in this section and the applicable sections of Chapters 2 through 7. This requirement was not met as evidenced by: Licensee did not discuss	1 2 3 4 5 6 7	Plan of Correction Licensee agrees to submit in writing the understanding of this regulation by POC due date 08/25/23
	8 9 10 11 12 13 14	R1's needs and service plan and diagnosis with R1 in a private location which poses a potential health safety and personal rights risk to residents in care.	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.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3