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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700065
Report Date: 12/11/2023
Date Signed: 12/11/2023 12:03:14 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/09/2023 and conducted by Evaluator Maja Jensen
COMPLAINT CONTROL NUMBER: 27-AS-20230809130307
FACILITY NAME:WILTON STABLESFACILITY NUMBER:
342700065
ADMINISTRATOR:TANYA BARRETOFACILITY TYPE:
735
ADDRESS:11119 MANN ROADTELEPHONE:
(916) 687-4548
CITY:WILTONSTATE: CAZIP CODE:
95693
CAPACITY:4CENSUS: 4DATE:
12/11/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ramone RomoTIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Staff yelled at residents in care
Staff does not allow resident to leave bedroom for an extended period of time.
INVESTIGATION FINDINGS:
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On 12/11/23 at approximately 11:00am, Licing Program Analyst Maja Jensen arrived at facility unannounced to continue an investigation in to the above listed allegation. LPA Jensen met with Ramone Romo and explained the purpose of today's visit.

During the course of the course of the investigation, LPA Jensen interviewed the former Administrator, Tanya Baretto, the cuirrent Administrator, Kolu Sokodolo, 3 staff members and 2 current residents.

Allegation 1 - Staff yelled at residents in care:
3 of 3 staff members and 2 of 2 residents stated that staff 1 (S1) yelled at residents in care. Based on interviews conducted which were all consistent in confirming that S1 yelled at residents, the allegation is SUBSTANTIATED. A finding of substantiated means that the prepnderance of evidence standard has been met.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
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 27-AS-20230809130307
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WILTON STABLES
FACILITY NUMBER: 342700065
VISIT DATE: 12/11/2023
NARRATIVE
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Allegation 2 Staff does not allow resident to leave bedroom for an extended period of time:
During the course of interviews conducted with residents, 2 of 2 residents interviewed stated that they were forced to stay in their rooms when they did not want to. During the course of interviews conducted with staff, 1 staff member stated they witnessed S1 make residents stay in their room. 1 of 3 staff members stated they believe the allegation to be true based on what they heard from other employees but never personally witnessed this occur, and 1 of 3 staff members stated that residents chose to stay in their room to avoid S1. Based on the interviews conducted the allegation is SUBSTANTIATED.

Deficiencies are being cited from the California Code of Regulations (CCR) Title 22, Division 6.

An exit interview was conducted and a copy of this report, the confidential names list ( LIC 811) and appeal rights were provided.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20230809130307
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WILTON STABLES
FACILITY NUMBER: 342700065
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/11/2023
Section Cited
CCR
80072(a)(1)
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Personal Rights
...each client shall have personal rights which include, but are not limited to, the following:
(1) To be accorded dignity in his/her personal relationships with staff and other persons. This requirement was not met as evidenced by:

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The Licensee has removed S1 from the facility, appointed a new Administrator and assigned a Regional Manager for oversight of the Administrator. No further plan of correction is needed.
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Based on interviews conducted, both staff and resident confirmed that S1 regularly yelled at residents in care. This poses an immediate risk to the health, safety and personal rights of residents in care.
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Type A
12/11/2023
Section Cited
CCR
80072(a)(3)
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Personal Rights
...each client shall have personal rights which include, but are not limited to, the following:
To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature, including but not limited to: interference with the daily living functions...
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The Licensee has removed S1 from the facility, appointed a new Administrator and assigned a Regional Manager for oversight of the Administrator. No further plan of correction is needed.
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This requirement was not met as evidenced by interviews conducted by LPA Jensen. This poses an immediate risk to the health, safety and personal rights of 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: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3