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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700914
Report Date: 08/09/2024
Date Signed: 08/16/2024 02:15:06 PM

Document Has Been Signed on 08/16/2024 02:15 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:POND BROOK HOME, INC.FACILITY NUMBER:
342700914
ADMINISTRATOR/
DIRECTOR:		CARPIO, ORLANDOFACILITY TYPE:
735
ADDRESS:8183 POND BROOK WAYTELEPHONE:
(916) 476-0882
CITY:ELK GROVESTATE: CAZIP CODE:
95758
CAPACITY: 4CENSUS: 3DATE:
08/09/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Orlando CarpioTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Vincent Moleski, Licensing Program Manager (LPM) Stephen Richardson, Alta California Regional Center (ACRC) Service Coordinator Sharon Mendy, and licensee/administrator Orlando Carpio met via Microsoft Teams on 8/9/24 to discuss the number of false complaints filed by a resident (R1), and other ongoing issues involving R1.

LPM Richardson asked what had been done since the previous meeting, also discussing R1, in order to reduce R1's behaviors. Mendy said that R1 has been receiving crisis management phone services, and has recently begun receiving in-person visits from crisis management personnel. Mendy also said that a disability rights attorney had attended R1's recent IPP meeting in order to discuss R1's medication refusals, but R1's mother has continued to encourage R1 to refuse their medications, and R1 has continued to refuse their medications.

LPM Richardson asked if any steps had been taken toward legally denying R1's access to their cell phone due to numerous false reports to both CCLD and law enforcement. Mendy said this possibility has been discussed with the disability rights attorney.

LPM Richardson asked about behavior intervention plans in place to encourage R1 to take their medication. Carpio said there had been plans in place to that effect, but R1 complained to CCLD that they were being "bribed" to take medications. All allegations regarding forced medication administrations at this facility have been determined to be either unsubstantiated or unfounded. Mendy said that ACRC was considering bringing in new behavior consultants to utilize different techniques to reduce behaviors from R1.

LPM Richardson said that R1's continued disruptive behaviors could jeopardize their placement. Carpio said that R1 was also refusing to walk on their own and preferred to use walkers and a wheelchair.
[continued on 809-C]
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE: DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: POND BROOK HOME, INC.
FACILITY NUMBER: 342700914
VISIT DATE: 08/09/2024
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LPM Richardson said that, because this facility's fire clearance only permits ambulatory residents, if R1's physician determined that they were, in fact, non-ambulatory (for example, on an updated LIC 602), Carpio could either seek a new fire clearance or issue a 30-day notice to R1.

LPM Richardson suggested that all parties meet again at a later date to discuss continued efforts among R1's family members to encourage R1 to take their medications, denial of rights for R1's use of their phone, crisis management services for R1, and additional behavior intervention techniques.

An exit interview was held with Carpio, and a copy of this report was sent to him to sign.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 08/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/09/2024
LIC809 (FAS) - (06/04)
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