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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700203
Report Date: 11/29/2021
Date Signed: 11/29/2021 11:21:15 AM

Unsubstantiated


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
09/13/2021 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 25-AS-20210913100548
FACILITY NAME:PEOPLE'S CARE KEYESPORT WAYFACILITY NUMBER:
342700203
ADMINISTRATOR:MORGAN RAYFACILITY TYPE:
735
ADDRESS:8317 KEYESPORT WAYTELEPHONE:
(909) 342-7163
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:4CENSUS: 4DATE:
11/29/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Amanda Brit, AdministratorTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility staff speak inappropriately to a resident in care
Residents not accorded dignity in relationship with staff
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to deliver findings in allegations listed above. LPA met with administrator, Amanda Britt, during today's inspection. 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. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Masks. Additionally, LPA was screened by staff upon entering the facility.
LPA investigated allegation, “Facility staff speak inappropriately to a resident in care”. LPA interviewed staff and clients in care. LPA interviewed client (C1) in which they stated staff were talking inappropriately to client. LPA interviewed 1 other client in care in which they stated staff are nice and do not talk inappropriately to them. LPA interviewed 5 staff members in which they stated they have not witnessed staff talking inappropriately to C1 or other clients in care. Due to the information gathered, LPA finds allegation to be unsubstantiated.
Continuation on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
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 4
Control Number 25-AS-20210913100548
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: PEOPLE'S CARE KEYESPORT WAY
FACILITY NUMBER: 342700203
VISIT DATE: 11/29/2021
NARRATIVE
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LPA investigated allegation, “Residents not accorded dignity in relationship with staff”. LPA interviewed staff and clients in care. LPA interviewed client (C1) in which they stated staff members entered their room and began throwing their clothing on the ground. Staff members that C1 stated threw their clothing, no longer work at the facility and LPA was unable to interview. LPA interviewed 5 staff members, in which they stated they only enter C1’s room with his permission. 3 staff members employed at the facility at the time of the incident, stated they did not observe or hear of staff throwing C1’s clothing on the floor. Due to the information gathered LPA finds allegation to be Unsubstantiated.

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.

Exit interview conducted.
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 11/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/29/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4