342700949-5-17-2023-27-AS-SRIN-CS4VZX-20230523165328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342700949
Report Date: 05/09/2023
Date Signed: 05/17/2023 01:29:03 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
01/19/2023 and conducted by Evaluator Christina Valerio

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230119165056

FACILITY NAME:	FIELDALE FACILITY		FACILITY NUMBER:	342700949
ADMINISTRATOR:	HUFF, MARCUS		FACILITY TYPE:	735
ADDRESS:	6261 FIELDALE DRIVE		TELEPHONE:	(323) 459-8068
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95758
CAPACITY:	4	CENSUS: 3	DATE:	05/09/2023
		UNANNOUNCED	TIME BEGAN:	03:03 PM
MET WITH:	Lavonne Huff and Marcus Huff		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff are not providing supervision on the weekends
Residents are not receiving medications as prescribed
Residents are not allowed to choose outings
Residents are forced to stay in vehicle when on outing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christina Valerio arrived to the facility unannounced to deliver complaint investigation findings. LPA met with Licensee LaVonne Huff, and explained the purpose of the visit.

The department has determined the following as it relates the aforementioned allegations.

Staff are not providing supervision on the weekends: On Saturday January 21st, 2023, LPA Valerio made an unannounced visit. Two staff members were on shift. According to interviews with residents and staff, all interviews show that there are staff on shift at all times. According to records review, facility records reveal that there is a minimum of 2 staff on shift from the hours of 6:00 AM - 11:00 PM.

Continues on LIC 9099 - C...
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This report was amended to change from confidential to public.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230119165056

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: FIELDALE FACILITY	FACILITY NUMBER: 342700949
	VISIT DATE: 05/09/2023

NARRATIVE

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Continued from LIC 9099

Residents are not receiving medications as prescribed: LPA Valerio reviewed facility records. Medication Administration Records (MAR) reviewed showed that the residents were given medications each day of the month for January 2023. The MAR is a paper record and therefore does not note the specific time of when the medication was given. For example, if a medication is ordered to be given at 8:00 PM, there is a box for staff to sign off that it was given. There were no empty boxes observed. According to an outside agency, it was reported that a resident was refused medication by staff. Interviews conducted by LPA Valerio with staff and residents did not indicate that residents are not receiving medications as prescribed.

Residents are not allowed to choose outings: During LPA's visit on 01/21/23, LPA obtained picture copies of the facility outing schedule. The outing schedule is written on an erasable white board. According to the staff interviews, the residents are able to choose the outings for the week. Residents like to go to the movies, to get food, to the thrift store, and to department stores. According to interviews with residents, they go to the Dollar Tree Store, Carl's Jr., McDonald's, and Fat Burger.

Residents are forced to stay in vehicle when on outing: According to interviews with residents, all residents interviewed stated they are able to exit the vehicle on outings. According to interviews with staff, there is not a time where residents were not allowed to exit a vehicle on an outing.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated.

Per California Code of Regulation (CCR), Title 22, no deficiencies were observed. An exit interview was held with Licensee Lavonne Huff and Marcus Huff, and a copy of the report provided.

SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Christina Valerio
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2023

LIC9099 (FAS) - (06/04)

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