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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 345002915
Report Date: 02/22/2024
Date Signed: 02/22/2024 09:40:02 AM

Substantiated


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
11/17/2023 and conducted by Evaluator Cheyenne Ratajczak
COMPLAINT CONTROL NUMBER: 59-AS-20231117161503
FACILITY NAME:RCCA COMMUNITY ACCESS PROGRAMFACILITY NUMBER:
345002915
ADMINISTRATOR:ELSTON, SHARRAEFACILITY TYPE:
775
ADDRESS:4980 WATT AVENUE SUITE CTELEPHONE:
(530) 933-1590
CITY:NORTH HIGHLANDSSTATE: CAZIP CODE:
95660
CAPACITY:43CENSUS: DATE:
02/22/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:TIME COMPLETED:
09:39 AM
ALLEGATION(S):
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Staff left clients in urine soaked clothing for an extended period of time.
INVESTIGATION FINDINGS:
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On 02/22/24, Licensing Program Analyst (LPA) Cheyenne Ratajczak arrived at the facility unannounced to deliver final findings for the complaint Community Care Licensing (CCL) received on 11/17/23. LPA met with Program Manager (PM), Ashley Thomas, and explained the purpose of the visit.

During the course of this investigation, the Department conducted interviews and obtained pertinent documents relevant to the complaint investigation.

Please continue to LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
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 3
Control Number 59-AS-20231117161503
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: RCCA COMMUNITY ACCESS PROGRAM
FACILITY NUMBER: 345002915
VISIT DATE: 02/22/2024
NARRATIVE
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Allegation: Staff left clients in urine-soaked clothing for an extended period of time. Substantiated

LPA conducted interviews regarding this allegation. During interviews, it was learned that before C1 left their house to leave to the facility, C1’s responsible party would write on C1’s brief. Witness stated that on 10/30/2023, C1 returned home after program with their brief soiled with urine and feces. It was noted that the soiled brief was the same brief with the same writing from that morning when C1 left to go to the day program. Based on C1’s needs and service plan C1 requires assistance with toileting needs.

Based on the information obtained, the facility did not meet C1’s toileting needs resulting in C1 being left in the same brief all day and returning home soiled with urine and feces, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D

Exit interview conducted and a copy of the report and appeal rights were left at the facility.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 59-AS-20231117161503
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: RCCA COMMUNITY ACCESS PROGRAM
FACILITY NUMBER: 345002915
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/23/2024
Section Cited
CCR
82077.4(b)(4)
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Care for Clients with Incontinence
(b)If a licensee accepts or retains a client who has bowel and/or bladder incontinence, the licensee is responsible for all of the following:
(4) Ensuring that a client is kept clean and dry, and that the day program remains free of odors.
This requirement is not met as evidenced by:
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Facility shall submit a plan to the Department regarding serving clients who are incontinent. The plan shall include but is not limited to, how facility will document client’s toileting needs, how facility will train staff on needs of clients who require toileting assistance and how facility will develop and implement a toileting plan for each client who requires assistance with toileting.
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Based on interview, the licensee did not comply with the section cited above, staff are not following toileting procedures, which poses an immediate health, safety and personal rights risk to persons 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: Laura Munoz
LICENSING EVALUATOR NAME: Cheyenne Ratajczak
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3