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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 317003807
Report Date: 09/26/2022
Date Signed: 09/26/2022 11:13:02 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20220214100931
FACILITY NAME:BADETTE'S PLACE INC.FACILITY NUMBER:
317003807
ADMINISTRATOR:CARRILLO, BLESFACILITY TYPE:
735
ADDRESS:9455 DUFFY LANETELEPHONE:
(916) 773-1925
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:4CENSUS: 4DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator-Bles CarrilloTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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9
Facility is locking residents in the facility.
Facility is not meeting residents needs: Facility is not providing 1:1 care for a resident who requires 1:1 care.
Licensee is falsifying records.
INVESTIGATION FINDINGS:
1
2
3
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5
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7
8
9
10
11
12
13
 On 09/26/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit and deliver the findings for the above allegations and met with Administrator-Bles Carrillo. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility.

The department conducted records review, facility observation and extensive interviews for this complaint investigation.


**Report continued on LIC9099-C**
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
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 9
Control Number 25-AS-20220214100931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BADETTE'S PLACE INC.
FACILITY NUMBER: 317003807
VISIT DATE: 09/26/2022
NARRATIVE
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** Report continued from 9099:

Facility is locking residents in the facility - SUBSTANTIATED


The Department conducted interviews and facility observation to investigate this allegation. Based on interviews with 3 staff and observations on 02/14/22 and 03/23/22 by CCL staff, it has been determined that facility was using pad lock on the main entry facility door to keep the residents inside which is a violation resident’s personal rights. Based on interviews and facility observations conducted by the department, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED.


Facility is not meeting residents needs: Facility is not providing 1:1 care for a resident who requires 1:1 care-SUBSTANTIATED

The Department conducted interviews and reviewed records to investigate this allegation. Based on interviews and record review, department has concluded that facility is not providing required 1:1 care for a (R1) who, based on care plan, requires 16 hours per day of 1:1 care. Facility administrator (A1) and co-administrator (A2) stated to CCL staff during 03/23/22 visit that facility is providing 1:1 care to R1 but failed to keep the proper records or schedule to verify those services were provided. Based on interviews and records review conducted by the department, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED.



**Report continued on LIC9099-C**
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 25-AS-20220214100931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BADETTE'S PLACE INC.
FACILITY NUMBER: 317003807
VISIT DATE: 09/26/2022
NARRATIVE
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** Report continued from 9099-C:

Licensee is falsifying records - SUBSTANTIATED


The Department conducted interviews and reviewed records to investigate this allegation. Based on 3 staff interviews and facility record review of facility staffing schedules, the Department has concluded that the licensees falsified staffing schedules regarding staff work schedule and staffs actual hours worked. Facility administrator (A1) and co-administrator (A2) stated to CCL staff during 03/23/22 visit that facility was providing services all required services/hours to all residents but did not keep proper records of schedule/hours. Department has concluded that facility is falsifying records. Based on interviews, facility observations and records review conducted by the department, the preponderance of evidence standards has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

Based on facility observations, interviews conducted by the department and records reviewed, the preponderance of evidence standards has been met. Therefore, all these allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached LIC9099-D page.



Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. The Administrator’s signature on these forms acknowledges receipt of these documents.







SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 25-AS-20220214100931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BADETTE'S PLACE INC.
FACILITY NUMBER: 317003807
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/27/2022
Section Cited
CCR
80072(a)(7)
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7
80072(a)(7)-Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following:
(7) Not to be locked in any room, building, or facility premises by day or night.
This requirement is not met as evidence by:
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7
Licensee will complete a statement of understanding indicating that the facility is aware of regulation 80072(a)(7) and outside area should be accessible to residents with facility staff’s care and supervision. Facility will submit statement of understanding and schedule for training to department by POC due date-09/27/22.
8
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Based on observation and interviews conducted, the facility used pad lock on main facility door to keep the residents inside. This poses an immediate health and safety risk to residents in care.
8
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13
14
Type B
10/10/2022
Section Cited
CCR
85078
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7
85078-Responsibility for Providing Care and Supervision-
In addition to Section 80078, the following shall apply: (1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement is not met as evidence by:
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Licensee will complete a statement of understanding indicating that the facility is aware of regulation 85078 and will provide care and supervision to residents per care plan agreement. Facility will submit statement of understanding and schedule for training to department by POC due date-10/10/22.
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Based on records review and interviews conducted, the facility did not provide proper record that facility provide required 1:1 care for R1 which poses a potential health and safety risk to residents in care.
8
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14
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: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 25-AS-20220214100931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BADETTE'S PLACE INC.
FACILITY NUMBER: 317003807
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/10/2022
Section Cited
CCR
80012
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80012 False Claims
(a)No licensee, officer, or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement is not met as evidence by:
1
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Licensee will complete a statement of understanding indicating that the facility is aware of regulation 80012 and shall not falsify any facility records. Facility will submit statement of understanding and schedule for training to department by POC due date-10/10/22.
8
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Based on records review and interviews conducted, the facility falsified staffing schedules in regard to staffing schedule and staffing actual hours worked which poses a potential health and safety risk to residents 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: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/14/2022 and conducted by Evaluator Talwinder Bains
COMPLAINT CONTROL NUMBER: 25-AS-20220214100931

FACILITY NAME:BADETTE'S PLACE INC.FACILITY NUMBER:
317003807
ADMINISTRATOR:CARRILLO, BLESFACILITY TYPE:
735
ADDRESS:9455 DUFFY LANETELEPHONE:
(916) 773-1925
CITY:ROSEVILLESTATE: CAZIP CODE:
95747
CAPACITY:4CENSUS: 4DATE:
09/26/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator-Bles CarrilloTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Uncleared staff working at the facility.
Licensee is threatening retaliation against staff who report to CCL and/or Regional Center.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 09/26/22, Licensing Program Analyst (LPA) Talwinder Bains conducted an unannounced complaint investigation visit and deliver the findings for the above allegations and met with Administrator-Bles Carrillo. Prior to initiating the complaint visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Upon arrival, completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask. Additionally, LPA was screened with temperature at the facility.

The department conducted records review, facility observation and extensive interviews for this complaint investigation.


**Report continued on LIC9099-C**
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 25-AS-20220214100931
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: BADETTE'S PLACE INC.
FACILITY NUMBER: 317003807
VISIT DATE: 09/26/2022
NARRATIVE
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** Report continued from 9099-A:

Uncleared staff working at the facility - Unsubstantiated



The Department conducted interviews, facility observations and reviewed facility records to investigate the allegation of uncleared staff working after business hours in the facility. CCL staff conducted facility visits on 02/14/22 and 03/23/22 and did not observe any uncleared staff working at the facility or providing any care to residents. CCL staff also interviewed facility administrators (A1 and A2) and other facility staff during investigation whom all stated all staff working at the facility are fingerprint cleared and associated to the facility. Based on department’s investigation as stated above, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Licensee is threatening retaliation against staff who report to CCL and/or Regional Center - Unsubstantiated

The Department conducted interviews and reviewed facility records to investigate this allegation. The Department has conducted interviews with several former and current staff as well as Administrators (A1 and A2) regarding this allegation. All individuals interviewed denied that licensees threatening or retaliated facility staff however, licensee did ask staff to provide false information in regard to staffing schedules and hours. Based on department’s investigation as stated above, the preponderance of evidence standards has not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 9