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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700238
Report Date: 03/17/2023
Date Signed: 03/21/2023 02:51:43 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/01/2022 and conducted by Evaluator Arielle Pascua
COMPLAINT CONTROL NUMBER: 27-AS-20221201142548
FACILITY NAME:SEVEN STARS CARE HOMEFACILITY NUMBER:
342700238
ADMINISTRATOR:SARAH MIKAILFACILITY TYPE:
735
ADDRESS:1317 COFFEE VILLA DRIVETELEPHONE:
(209) 595-8534
CITY:MODESTOSTATE: CAZIP CODE:
95355
CAPACITY:6CENSUS: 3DATE:
03/17/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Sarah Mikail TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff handled resident in rough manner.
Staff made inappropriate comments towards resident
Staff inappropriately took pictures of resident
Staff did not provide resident with privacy
Staff did not provide resident with dignity
Staff did not make sure facility phone was not in disrepair
INVESTIGATION FINDINGS:
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On 02/29/2023 at 10:00am, Licensing Program Analyst (LPA) Arielle Pascua arrived at the facility unannounced to conduct a complaint visit. LPA Pascua was greeted by Facility Designated Administrator, Sarah Mikail and explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegations above. Current census was 3. 3 out of 3 residents were out at their respective day programs at this time. A tour of the facility was conducted and a brief interview with conducted with FDA Mikail.

During the course of this investigation, LPA Pascua conducted staff and resident interviews and reviewed facility files.

Allegation: Staff handled resident in rough manner
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
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-20221201142548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SEVEN STARS CARE HOME
FACILITY NUMBER: 342700238
VISIT DATE: 03/17/2023
NARRATIVE
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It was alleged that staff handled resident in a rough manner. Based on interviews and information gathered during the course of this investigation, it was revealed that facility staff did not handle R1 in a rough manner. 1 out of 4 residents interviewed stated that R1 was angry with facility staff and did not allow them to calm them down. An interview with facility staff was conducted and it was denied that facility staff ever handled R1 in a rough manner. Interviews with 4 residents were conducted. 4 out of 4 residents denied ever being held in a rough manner by facility staff. All residents also denied to ever witnessing any other residents being held in a rough manner. It is unclear at this time if staff handled a resident in a rough manner.

Allegation: Staff made inappropriate comments towards resident

It was alleged that staff made inappropriate comments towards resident. Based on interviews and information gather during the course of this investigation, it was revealed that facility staff was trying to calm R1 down from being upset. Facility staff told R1 that maybe it was best that they go into their room to calm down instead of the couch but R1 denied. An interview with 4 residents were conducted. 1 out 4 residents witnessed the incident between R1 and facility staff and it was denied that they heard facility staff make inappropriate comments towards residents. 1 out of 4 residents stated that staff may not make inappropriate comments but the way staff makes comments may be taken a different way. 2 out of residents denies staff making inappropriate comments towards them or other residents. It is unclear at this time if staff made inappropriate comments towards a resident.

Allegation: Staff inappropriately took pictures of resident

It was alleged that staff inappropriately took pictures of resident. Based on interviews and information gathered during the course of this investigation, it was learned that R1 alleged facility staff was taking pictures of them while sitting on the couch. An interview was conducted with facility staff and it was denied that they were taking pictures of the resident. It was stated by facility staff that they were taking pictures of areas surrounding the resident due to the damages that the resident had done at the time. An interview with 1 resident who witnessed the incident could not confirm or deny that facility staff was taking pictures of the resident. An interview with 2 additional residents was conducted. 2 out of 2 residents stated that they did not witness the incident and could not confirm that staff took pictures of any residents. It is unclear at this time if staff inappropriately took pictures of a resident.

SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 27-AS-20221201142548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME: SEVEN STARS CARE HOME
FACILITY NUMBER: 342700238
VISIT DATE: 03/17/2023
NARRATIVE
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Allegation: Staff did not provide resident with privacy

It was alleged that staff did not provide resident with privacy. Based on interviews and information gathered it was learned that when R1 came home from their time away from the home they noticed that some of their belongings were moved in their room and the bedroom door was not locked. It was stated by R1 that they asked for facility staff that they were able to touch their belongings but could not fold their clothes. R1 stated that this could have been a misunderstanding between them and facility staff. R1 reports that they are given privacy most of the time but it is hard because they have a roommate. An interview with facility staff was conducted and it was learned that another staff member went into the room to clean up the floor while the residents were out of the facility. The facility staff misunderstood the resident and began to do the residents laundry and place them on the bed. Facility staff stated that they provide all residents with privacy and do not think that there is an issue. Additionally, 3 resident interviews were conducted. 3 out of 3 residents state that the facility staff provides them privacy and do not have any issues at this time. Based on the interviews and information that was gathered it is unclear that staff did not provide a resident with privacy.

Allegation: Staff did not provide resident with dignity

It was alleged that staff did not provide resident with dignity. During the course of this investigation, LPA interviewed 4 residents. 1 out of 4 residents stated that they felt that the facility staff did not provide them with dignity and did not allow them to be as independent as they would like. 3 out of 4 residents stated that the facility staff did provide them with dignity and allowed them to be independent and respected their personal spaces. An interview with facility staff revealed that the facility has had some issues with R1 but has been contacting their Service Coordinator about any issues that may come across. Facility staff also denies that they do not provide residents with dignity. Based on the interviews and information gathered it is unclear that the staff did not provide the resident with dignity.

Allegation: Staff did not make sure facility phone was not in disrepair

It was alleged that staff did not make sure that the facility phone was not in disrepair. Based on interviews and observation, it was learned that the facility phone was available and working for the residents to use on a daily basis. An interview with the facility administrator was conducted and it was learned that the facility phone was working but it was hard to hear others one the other line. The facility administrator stated that she fixed the issue before and should be working now. An interview with 4 residents was conducted. 1 out of 4 residents stated that she used the facility phone before but it stated by this resident that it was hard for other people to hear them on the phone. This resident also stated that they have not used the phone lately because they use their own phone. 2 out of 4 residents state that they have used the phone and have never had an issue. 1 out of 4 residents state they do not use a phone. Additionally, LPA Pascua called the facility phone twice and was observed to be in good repair at this time. Based on interviews and observation, it is unclear if the staff did not make sure the facility phone was not in disrepair.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.



There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arielle PascuaTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3