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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209319
Report Date: 10/23/2023
Date Signed: 10/23/2023 02:21:13 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
09/25/2023 and conducted by Evaluator Shawna Doucette
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230925092844
FACILITY NAME:CENTER STREET BOARD AND CARE 2FACILITY NUMBER:
157209319
ADMINISTRATOR:BARBATO, ANTHONYFACILITY TYPE:
735
ADDRESS:2451 CENTER STTELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:18CENSUS: 18DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Administrator Katie BlairTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not ensure that resident was administered their medication(s) in a timely manner.
INVESTIGATION FINDINGS:
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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 Katie Blair.

LPA reviewed records and interviewed staff. During records review it was found C1's PRN was instructed to be given as needed every 6 hours. After reviewing MARS log C1 was given the medication before the 6 hours on 09/20/23, 09/27/23 and 09/28/23.

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 Katie Blair 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: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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
Control Number 24-AS-20230925092844
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: 10/23/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/24/2023
Section Cited
CCR
80075(b)
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80075 Health Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. This requirement was not met as evidenced by C1's PRN was not given as instructed on
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Plan of Correction POC Licensee agrees to submit agenda and staff sign in sheet of medication training by POC due date. POC cleared during visit. Training conducted on 10/6/23.
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09/20/23, 09/27/23 and 09/28/23 which poses an immediate health safety and or personal rights 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: 10/23/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
LIC9099 (FAS) - (06/04)
Page: 2 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
09/25/2023 and conducted by Evaluator Shawna Doucette
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230925092844

FACILITY NAME:CENTER STREET BOARD AND CARE 2FACILITY NUMBER:
157209319
ADMINISTRATOR:BARBATO, ANTHONYFACILITY TYPE:
735
ADDRESS:2451 CENTER STTELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:18CENSUS: 18DATE:
10/23/2023
UNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:Administrator Katie BlairTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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2
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9
Staff do not ensure that resident(s) possessions are safeguarded.
Staff do not treat residents equally.
INVESTIGATION FINDINGS:
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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 Katie Blair.

LPA interviewed staff and residents. During the course of the interviews, if was found that it was undetermined if the property was stolen due to it being found in C1's drawer where she keeps it.
During the course of interviews, it was found that it is undetermined if staff treat clients equally.

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: 10/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023
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