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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701386
Report Date: 10/07/2024
Date Signed: 10/07/2024 01:33:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
06/04/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240604103840
FACILITY NAME:WELLCARE HOMES 5 - BELPORT HOMEFACILITY NUMBER:
342701386
ADMINISTRATOR:CAMALIG, YVONNEFACILITY TYPE:
737
ADDRESS:2540 BELPORT LNTELEPHONE:
(916) 230-4087
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:4CENSUS: 3DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Vonne CamaligTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff do not meet the personnel requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Yvonne Camalig and explained the purpose of the visit.

This investigation consisted of interviews and record review. LPA Moleski interviewed 10 staff members (S1-S10). LPA Moleski reviewed 25 personnel files (S2-S8, S11-S28).

One of the staff records reviewed, one staff member (S11) appeared to lack the required experience to work as a direct care staff person. 22 CCR Section 89965 requires all direct care staff members to have six months work experience providing direct care to persons with developmental disabilities before starting work at an Enhanced Behavioral Supports Home. S11’s LIC 501 indicated that S11 had prior work experience in catering and had worked in a Residential Care Facility for the Elderly (RCFE). [continued on 9099-C]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
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 27-AS-20240604103840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WELLCARE HOMES 5 - BELPORT HOME
FACILITY NUMBER: 342701386
VISIT DATE: 10/07/2024
NARRATIVE
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LPA Moleski reviewed Guardian records and observed that S11 had only ever been associated to RCFEs prior to their hire at Wellcare Homes 5, and had never been associated to any facilities serving adults with developmental disabilities. S11 was associated to this facility for over a month, according to Guardian records.

All other staff files reviewed by LPA Moleski had the requisite work experience, according to their LIC 501 forms.

LPA Moleski observed on file in all staff records reviewed all requisite health screenings and tuberculosis test results.

The department has determined the following as it relates to the allegation that staff do not meet the personnel requirements:

Based on record review, the above allegation is SUBSTANTIATED. A finding that the complaint allegation is substantiated means that the allegation is valid because the preponderance of evidence standard has been met.

This facility is hereby cited per 22 CCR Section 89965(b)(1). An exit interview was held with Camalig. Appeal rights and a copy of this report were left with Camalig.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
06/04/2024 and conducted by Evaluator Vincent Moleski
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20240604103840

FACILITY NAME:WELLCARE HOMES 5 - BELPORT HOMEFACILITY NUMBER:
342701386
ADMINISTRATOR:CAMALIG, YVONNEFACILITY TYPE:
737
ADDRESS:2540 BELPORT LNTELEPHONE:
(916) 230-4087
CITY:SACRAMENTOSTATE: CAZIP CODE:
95821
CAPACITY:4CENSUS: 3DATE:
10/07/2024
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Vonne CamaligTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff do not meet the training requirements.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to deliver findings on this complaint investigation. LPA Moleski met with facility administrator Yvonne Camalig and explained the purpose of the visit.

This investigation consisted of interviews and record review. LPA Moleski interviewed 10 staff members (S1-S10). LPA Moleski reviewed 25 personnel files (S2-S8, S11-S28).

LPA Moleski observed in the files reviewed that all staff members had documentation of the minimum 16 hours of emergency intervention training. This training was comprised of Ukeru training and Pro-Act training. In an interview, S1 said that some staff members (S10, S3, and S5) were not provided full Ukeru training. In an interview, S10 said that they had previously completed their Ukeru training while working at a different facility. [continued on 9099-C]
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20240604103840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: WELLCARE HOMES 5 - BELPORT HOME
FACILITY NUMBER: 342701386
VISIT DATE: 10/07/2024
NARRATIVE
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 LPA Moleski observed 18 hours of Pro-Act training, plus their Ukeru training documented in their file. In an interview, S5 said that they had received approximately six hours of Ukeru training at this facility. LPA Moleski observed 18 hours of Pro-Act training plus their Ukeru training documented in their file. In an interview, S3 said they had received only about an hour of Ukeru training. LPA Moleski observed 18 hours of Pro-Act training plus their Ukeru training documented in S3’s file.

In interviews with S1-S2, S4, and S6-S10, LPA Moleski was not made aware of any further irregularities regarding Ukeru training. LPA Moleski observed documentation of required training for all other staff members. In an interview with this facility’s former training manager (S9), some trainings went faster due to previous work experience. S9 was not aware of any issues with untrained staff.

The department has determined the following as it relates to the allegation that staff do not meet the training requirements.

Based on interviews and record review, the above allegation is UNSUBSTANTIATED, which means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was left with Camalig.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 27-AS-20240604103840
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: WELLCARE HOMES 5 - BELPORT HOME
FACILITY NUMBER: 342701386
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/21/2024
Section Cited
CCR
89965(b)(1)
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“(b) The licensee shall ensure that each direct care staff person meets the following qualifications:
(1) Have six months prior experience providing direct care to individuals with developmental disabilities…” This requirement was not met as evidenced by:
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Licensee agrees to send LPA Moleski an updated hiring packet from management training on 10/16/24.
Vincent.moleski@dss.ca.gov
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Based on record review, the licensee hired a direct care staff member who did not have the requisite experience, which poses a potential health, safety, and/or personal rights risk to clients in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Vincent Moleski
LICENSING EVALUATOR SIGNATURE:

DATE: 10/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/07/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5