342700203-5-13-2025-59-AS-KHOS-DGPRC8-20250515125356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700203
Report Date: 05/13/2025
Date Signed: 05/13/2025 05:05:32 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
04/17/2025 and conducted by Evaluator Sabrina Calzada

PUBLIC

COMPLAINT CONTROL NUMBER: 59-AS-20250417094753

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:	02:45 PM
MET WITH:	Crystal Paulus, House Lead		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff engaged in a physical altercation with client.
Staff spoke to client inappropriately.

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. The Administrator was not able to attend during today's inspection. LPA observed (2) clients present during the investigation and (1) client was attending college program.

During the investigation, the Department conducted interviews, including with multiple facility staff, (2) representatives of service programs client (C1) participates in, client (C1) and the Ombudsman. The Department reviewed documentation related to (C1) including incident reports submitted by the facility, charting notes and other documentation. The results of the investigation are as follows:

NOTE: This complaint involves the same client and staff, for the same incident that occurred on 4/5/25, that was reported under complaint # 59-AS-20250410172217. This complaint is a different version. Findings were determined to be unsubstantiated or unfounded.

*cont on 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 4

Control Number 59-AS-20250417094753

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... On April 11, 2025, this staff stated she was off-site and called staff, (S1) and she heard (C1) emotionally apologizing to (S1) and he would take his meds", stating (C1) "only refused to take his meds that night for (S1) but takes them for all other staff". The lead 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.

A representative from the Regional Center stated (C1) initially stated he got into a physical fight with (S1) on 4/5/25; however, then changed the details of the story and confirmed he did not sustain any injuries or bruises from the physical altercation. A facility nurse confirmed on 4/10/25 that there were no bruises observed to (C1) following the incident.

The Ombudsman stated when (C1) described the incident to him, there were inconsistencies in (C1's) story with each telling. On 4/17/25, when meeting with (C1), (C1) began yelling at the Ombudsman when he told (C1) that while 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 he responded to Ombudsman's interview, it seems clear that (C1) did not respond to staff as calmly as he indicated he did.

The internal investigation notes the Administrator stated she was contacted on 4/5/25 by (S1) to confirm if (C1) could attend a dinner in downtown Sacramento without staff and she stated he could not without staff. Additionally, there were no approved drivers on the shift to drop off or pick up (C1) from the event. Further, the Administrator reported that (C1) was upset after being told he could not attend and began throwing items from his room and at staff and that (C1) was refusing his medications. The Administrator confirmed there were no other communications from staff that night about any additional incidents.

Charting notes entered by NOC staff, (S3) note that when (S3)arrived on 4/5/25 at 10:00 pm, he heard yelling and screaming and (S1) came outside and asked for assistance as (C1) 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).

*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)

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Control Number 59-AS-20250417094753

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 physical altercation with client. The allegation states that client (C1) reported a physical altercation that occurred between him and a staff member, staff (S1) on 4/5/25. The altercation involved (S1) threatening to hit him with a tennis racket in the kitchen area and then later pushing (C1) to the ground, so (C1) punched (S1), and (S1) had him on the ground so (C1) tried to grab (S1) face but instead grabbed her hair and snatched her wig off. Also it's alleged (S2) was recording the incident.

Staff (S2) stated she was present during the incident on 4/5/25 and observed (C1) to be in a behavioral all day, including throwing a water bottle, items from the refrigerator and a large trash can in the kitchen. (S2) confirmed she did record the incident and told (C1) and (S1) she was recording the incident at the start. (S2) stated she provided the recording to Lead Care Staff, who confirmed the video sent to her was only seconds in length and not clearly viewable.

Staff (S1) stated client (C1) "started throwing things at first in his room "around 2:00 pm at the start of her shift and staff, after (S1) told client he could not go downtown with friends for the evening. (C1) had a series of behaviors all afternoon and evening and refused dinner and medications, on multiple attempts. (S1) explained that (C1) will become upset with whoever makes him mad. (S1) stated when (C1) was "refusing to talk", 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" up until "cut off time, at 9:00 pm".

At 10:00 pm, male staff, (S3) who is friends with (C1), was walking up the driveway to start his shift and heard (C1) threatening (S1 and S2) and saw (C1) go into the kitchen and kick over the trash can. (C1) started throwing things from the refrigerator, 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.

Lead Staff stated (C1) is conserved and requires "eyes on him" at all times, except for when attending church, school or another approved program, and (C1) told her "three different versions when she returned" from vacation on April 9, 2025.
*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: 3 of 4

Control Number 59-AS-20250417094753

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. Charting notes entered by (S2) indicate (C1) was exhibiting many different behaviors, including kicking the doors and walls and verbally attacking and threatening to physically harm both staff on shift. (S2) stated to facility management she did not observe (S1) to place her hands on (C1) at any time.

The facility's District Manager stated the internal investigation found the allegation to be unsubstantiated. LPA was provided with a copy and observed it to contain a thorough interview of each staff involved as well as managers. The incident report submitted says (C1) made accusations about the staff throwing items at him and punching him in in his face. When (C1) was asked about different versions of the story, he 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.

Allegation: Staff spoke to client inappropriately. The allegation does not have specific details but said the altercation started with (S1) would not allow (C1) to go downtown with friends on 4/5/25.

Multiple interviews confirmed, including those conducted through the internal investigation, that when (S1) told (C1) he could not go downtown with friends in the evening, unsupervised, (C1) became upset and started throwing things at staff, kicking the door and his room and then verbally attacking staff (S1 and S2) who were on the "pm" shift that day. (C1) reported that staff told him he has "no rights to go out" and stated to many people and other staff he feels his rights are being violated. Charting notes from (S2) indicate (C1) was exhibiting many different behaviors, including kicking the doors and walls, verbally attacking and cussing at (S1 and S2), and threatening to physically harm both staff. (S3) stated (C1) and (S1) were engaging with each other verbally and doesn't remember exactly what (S1) said, but (S1) did raise her voice when (C1) continued to throw more items from the refrigerator at staff.

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.

Exit interview. Copy of report emailed to the Administrator.

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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