342700203-5-13-2025-59-AS-KHOS-DGPR7T-20250515124653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700203
Report Date: 05/13/2025
Date Signed: 05/13/2025 02:43:09 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH 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
04/10/2025 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20250410172217

FACILITY NAME:	PEOPLE'S CARE KEYESPORT WAY		FACILITY NUMBER:	342700203
ADMINISTRATOR:	AMANDA BRITT		FACILITY TYPE:	735
ADDRESS:	8317 KEYESPORT WAY		TELEPHONE:	(916) 735-5620
CITY:	CITRUS HEIGHTS	STATE: CA	ZIP CODE:	95610
CAPACITY:	4	CENSUS: 3	DATE:	05/13/2025
		UNANNOUNCED	TIME BEGAN:	02:20 PM
MET WITH:	Crystal Paulus, Administrator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff engaged in a verbal altercation with resident.
Staff pushed resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint investigation and met with Crystal Paulus (CP), House Lead. Also present was staff, Shay Winfrey, DSP. The Administrator was not able to be at the facility during this time. LPA observed (2) clients present during the inspection and (1) client was attending college program.

During the investigation, the Department conducted multiple interviews with facility staff, outside representatives, client (C1), and the Ombudsman. The Department reviewed documentation related to client (C1), the subject of the investigation, including charting notes, incident reports and an internal investigation summary.

The results of the investigation are as follows:

9099C-1..

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

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 5

Control Number 59-AS-20250410172217

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PEOPLE'S CARE KEYESPORT WAY	FACILITY NUMBER: 342700203
	VISIT DATE: 05/13/2025

NARRATIVE

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9099C-1.. Allegation: Staff engaged in a verbal altercation with client. The complaint alleges that on 4/5/25, (C1) got into a fist fight with staff (S1) due to (S1) stating (C1) could not go downtown with friends that evening.

(C1) stated to the Department that he wanted to go out to eat with a friend and a new staff told him the Administrator said he cannot leave and he doesn't have the right to leave.

Lead Staff stated she was on vacation and out of the facility on 4/5/25 when the alleged incident occurred. This staff stated that (C1) is conserved and requires "eyes on him" at all times, except for when he attends, church, school or another approved program. This lead staff stated (C1) told her "three different versions when she returned" on April 9, 2025. On April 11, 2025, this staff stated she was off-site and called staff, (S1) and she heard (C1) "sobbing and telling (S1) he was sorry and said he would take his meds", stating (C1) "only refused to take his meds that night for (S1) but takes them for all other staff". This staff stated
(S1) and (C1)"typically" get along but when (C1) was told he could not go out, as there was "no "pm" driver that night to pick up him", he became very upset.

Staff (S1) confirmed she was working on the "pm" shift on Saturday, April 5, 2025 and client (C1), was "in a behavioral all day" before the "pm" shift started and then was "trying to leave with friends around 9:00 pm and return around 1-2:00 am. (S1) confirmed (C1) asked if he could leave with friends and (S1) stated she told (C1) she would contact the Administrator, who said it was not okay for him to leave on this outing. (S1) explained (C1)"started throwing things at first in his room" around 2:00 pm at the start of her shift, wouldn't eat dinner or take medications for the evening, and at 10:00 pm, began throwing things in the kitchen and from the fridge. When (C1) took her purse that was on the counter, she ran to his room to get it and then (C1), began "hitting her" as she tried to grab her purse back. (S1) stated (C1)"punched her and kept punching her, giving her a bloody nose, black eye and hurt her jaw". (C1) was not observed to have any bruising or injuries which was also noted by staff, including a facility nurse.

An outside representative who knows (C1) stated (C1) has routinely had complaints about staff not knowing him well and not treating him like he is a high functioning and independent resident. This representative stated she had to remind (C1) to use his calming strategies while telling the story and the story was a bit confusing, but the gist was that (C1) wanted to go out with a friend and asked staff for medications, but staff told (C1) he could not go out and it escalated from there.
*cont on 9099C-2..

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 59-AS-20250410172217

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PEOPLE'S CARE KEYESPORT WAY	FACILITY NUMBER: 342700203
	VISIT DATE: 05/13/2025

NARRATIVE

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9099C-2... The Ombudsman stated he has known (C1) for some time and when (C1) described the incident to him, there were inconsistencies in (C1's) story with each telling.On 4/17/25, when Ombudsman was meeting with (C1), (C1) began yelling at the Ombudsman who told (C1) that while (C1) feels he is independent, due to his behavior, he needs staff supervision as all times. The Ombudsman stated he does not know what happened during the reported incident but from (C1's) telling and how (C1) responded to Ombudsman's interview, it seems clear that (C1) did not respond to staff as calmly as he indicated he did.

Charting notes entered by NOC staff, (S3) on the morning of 4/6/25 note that when (S3)arrived at 10:00 pm, he heard yelling and screaming and (S1) came outside and asked for assistance with (C1), who was "having a major behavioral problem". Notes state that (S3) heard (C1) to be "verbally attacking (S1), and they argued for a moment but it escalated to (C1) throwing things at (S1). The incident moved to (C1's) room and (S3) separated the client.

Charting notes entered by (S2) on 4/5/25 (2:00 pm) note that (C1) began to throw things in his room and kick doors when he was told he couldn't leave with friends on the evening of 4/5/25. (C1) went to the park, was followed by (S2), returned and then was verbally attacking both (S1) and (S2), trying to kick the doors and walls. Notes say (C1) refused dinner and medications, after multiple attempts, on 4/5/25.

The facility's District Manager indicated an internal investigation was conducted which found the allegation to be unsubstantiated or inconclusive. A copy of the report was provided,

Incident report submitted says (C1) made accusations about the staff throwing items at him and punching him in in his face. (C1) was asked about different versions of the story, retracted his story and then said the altercation didn't happen.

Based on information obtained, this allegation is found to be UNSUBSTANTIATED- meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

*cont on 9099C3-

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 59-AS-20250410172217

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: PEOPLE'S CARE KEYESPORT WAY	FACILITY NUMBER: 342700203
	VISIT DATE: 05/13/2025

NARRATIVE

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9099C-3.. Allegation: Staff pushed resident. The allegation states staff (S1) engaged in a verbal altercation with (C1) which escalated to (S1) pushing both her hands into (C1’s) chest, shoving (C1). (S1) then grabbed a bandana off (C1)s head causing (C1’s) sunglasses to fall and break and continued to push (C1), following him to his room.

Staff (S1 stated (C1) "started throwing things at first in his room "around 2:00 pm at the start of her shift and staff, (S2) walked away, after (S1) told client he could not go downtown with friends for the evening. (C1) then went outside and was cussing staff out, trying to AWOL and said he would leave with his friends and never return. (C1) left the house, followed by (S2) and when he returned went in his room but refused dinner from (S1) because she was the one that told him he couldn't go out. (S1) explained that (C1) will become upset with whoever makes him mad.

(S1) stated she kept offering (C1) dinner but (C1) didn't want to eat that day. (S1) stated after she got the other clients ready for bed, she went to (C1's) door but (C1) was "refusing to talk". (C1) stated she opened the door and called Lead staff, Crystal Paulus, around 7:00 pm to see if she could get (C1)to take his meds, but he "still refused his medications" and explained that (C1) wouldn't talk to her or (S2), but she kept trying to offer medications as late as possible, until "cut off time, at 9:00 pm".

At 10:00 pm, the male staff, (S3) who (C1) is friends with, was walking up the driveway to start the NOC shift. (C1) began threatening (S1 and S2) and went into the kitchen and kicked over the trash can as (S2) was leaving her shift. (C1) started throwing things from the refrigerator and then grabbed (S1's) purse and ran to his room with it. (S1) stated she followed client to get her purse, and (C1) began "hitting her" as she tried to grab her purse back. (S1) stated (C1) "punched her and kept punching her, giving her a bloody nose, black eye and hurt her jaw", commenting staff,(S3) "broke it up as he heard everything and saw (C1) grab my purse". (S1) stated she "had a wig on" and (C1)"attacked me" and four to five days later, (C1) apologized and was crying. (S1) stated there were no sunglasses involved in the incident.

Based on information obtained, this allegation is found to be UNSUBSTANTIATED- meaning that athough the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Sabrina Calzada
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025

LIC9099 (FAS) - (06/04)

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