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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006294
Report Date: 11/04/2025
Date Signed: 11/04/2025 01:57:45 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/03/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251103130129
FACILITY NAME:TELECARE STEPHANIE HOUSEFACILITY NUMBER:
306006294
ADMINISTRATOR:WOOTEN-NEWMAN, KRISTENFACILITY TYPE:
737
ADDRESS:11702 STEPHANIE LANETELEPHONE:
(657) 667-6382
CITY:GARDEN GROVESTATE: CAZIP CODE:
92840
CAPACITY:4CENSUS: 3DATE:
11/04/2025
UNANNOUNCEDTIME BEGAN:
07:55 AM
MET WITH:Kristen NewmanTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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The licensee did not follow the plan of operation
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Kristen Newman, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that the licensee did not follow the plan of operation revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, and obtained and reviewed copies of the client roster, staff roster, Client #1’s (C1) Individual Behavior Support Plan (IBSP), the facility’s plan of operation, and the facility’s staff training logs.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
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 22-AS-20251103130129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: TELECARE STEPHANIE HOUSE
FACILITY NUMBER: 306006294
VISIT DATE: 11/04/2025
NARRATIVE
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It was alleged that C1’s IBSP is incomplete and multiple staff did not receive their monthly 20-minute emergency intervention refresher training. LPA inspected the facility, conducted health and safety checks on clients, and observed no health and safety issues. LPA interviewed AD who denied that the facility’s IBSPs are incomplete, stating that recommendations for alterations to the IBSPs were made and the facility will be following those recommendations moving forward. LPA’s review of C1’s IBSP did not corroborate that the facility’s IBSPs are incomplete. The information obtained regarding the IBSPs is conflicting. Regarding the staff’s monthly 20-minute emergency intervention refresher training, AD admitted the allegation, stating the facility’s plan of operation requires direct care staff to receive monthly 20-minute emergency intervention refresher training and that some staff did not complete this requirement. LPA reviewed the facility’s plan of operation which confirms this training is required. LPA reviewed the facility’s staff training logs for April 2025 through September 2025 and confirmed S1, S2, S3 and S4 all missed at least one monthly 20-minute emergency intervention refresher training during this period.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20251103130129
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: TELECARE STEPHANIE HOUSE
FACILITY NUMBER: 306006294
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/02/2025
Section Cited
CCR
80022(k)
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80022 Plan of Operation (k) The facility shall operate in accordance with the terms specified in the Plan of Operation and may be cited for not doing so. This requirement was not met as evidenced by:
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Licensee stated they will ensure all staff complete the required training and submit proof to LPA by POC due date.
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Based on documents, the licensee did not ensure S1, S2, S3, and S4 completed all monthly 20-minute emergency intervention refresher trainings as required by the facility’s plan of operation, which poses a potential safety risk to persons 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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 11/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3