<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 347004223
Report Date: 03/24/2022
Date Signed: 03/24/2022 11:30:53 AM

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
01/10/2022 and conducted by Evaluator Jamie Ivey-Canady
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220110163907
FACILITY NAME:WHITE HORSE HOME, INC.FACILITY NUMBER:
347004223
ADMINISTRATOR:KATHY ABRIAM RHYMESFACILITY TYPE:
735
ADDRESS:9460 WHITE HORSE WAYTELEPHONE:
(916) 714-1925
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 4DATE:
03/24/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zeniada AbriamTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are verbally abusive to client.
Staff are being mentally abusive to client.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(s) (LPA) Jamie Ivey Canady and Christina Valerio arrived unannounced to conclude the investigation of the above mentioned allegation(s) on 03/24/22 at 9 am. LPAs were met by Licensee Zeniada Abriam, and stated the purpose of the visit.

The allegations were investigated by LPA Ivey Canady. The investigation consisted of interviews with staff (Staff 1 - Staff 6), interviews with residents (resident 1 - Resident 3), interviews with responsible party for R1 (RPR1), observations of interactions with staff and residents, records review of facility files, and records review of resident files.


Continued on LIC 9099 - C...
Page 1 of 2

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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 7
Control Number 27-AS-20220110163907
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: WHITE HORSE HOME, INC.
FACILITY NUMBER: 347004223
VISIT DATE: 03/24/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
According to staff interviews, all staff stated there was no verbal abuse towards residents. LPA interviews with R2 and R3 were deemed unsuccessful due to communication barriers.

According to interview with RPR1 staff is being mentally and verbally abusive to R1. RPR1 stated R1 has been ignored by staff and being called names. LPA Ivey Canady observed staff and client interaction while at the facility on 3 separate occasions. According to LPA Ivey Canady observation, R1 appears to have requests fulfilled quickly by staff. R1 is cognitively more advanced than the other residents and verbalizes wants and needs very well. LPA reviewed receipt documents of office furniture and computer that administrator identified as purchased specifically for R1 with R1's funds. LPA Ivey Canady observed area where the office furniture is set up and administrator identified the area as R1's own personal area. 

LPA Ivey Canady interviewed Reporting Party (RP) stated facility was asked to remove S5 from the facility schedule due to R1 family reporting S5 is rude to R1. Upon investigation, no direct evidence of S5 being rude was found. Upon further review, RP did not speak directly with R1. RP requested staff be removed from schedule based on complaint from 3rd party.
According to Resident 1 (R1) Individual Program Plan (IPP), R1 is on target with behavioral targets. Noted as a status of "met and ongoing" are behaviors defined as yelling at staff when they are in the same room and making demands without saying "please" or "thank you" or not allowing them to help when there is a safety concern." Per interview with administrator, there are times when staff yells at R1 when R1 is yelling because it is too loud in the facility and R1 cannot hear staff because R1 is yelling. According to all staff interviewed, the yelling is occurring because of the heightened noises made by all residents.  LPA observed R1 Behavioral Intervention Plan (BIP) does note increased incidents of R1 consistently yelling at staff. There are replacement behaviors and prevention procedures listed. LPA interview with all staff resulted with all staff stating the prevention procedures are being implemented.

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 Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was given to Licensee.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 7
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
01/10/2022 and conducted by Evaluator Jamie Ivey-Canady
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220110163907

FACILITY NAME:WHITE HORSE HOME, INC.FACILITY NUMBER:
347004223
ADMINISTRATOR:KATHY ABRIAM RHYMESFACILITY TYPE:
735
ADDRESS:9460 WHITE HORSE WAYTELEPHONE:
(916) 714-1925
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY:4CENSUS: 4DATE:
03/24/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Zeniada AbriamTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are interfering with client's communication with family.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst(s) (LPA) Jamie Ivey Canady and Christina Valerio arrived unannounced to conclude the investigation of the above mentioned allegation(s). LPAs were met by Licensee Zeniada Abriam.

LPA Ivey Canady interviewed RPR1 regarding allegation of staff not allowing R1 to speak openly to family about the facility. RPR1 reports hearing staff telling R1 to get off the phone when R1 began giving RPR1 information about the facility.

LPA Ivey Canady interviewed all residents (R1-R3) that reside in the home during time of visit on 3/9/2022 and 3/21/2022. LPA interviewed S1 regarding the allegation of not allowing resident to speak with family on the phone about the facility. S1 stated there was no intervention from staff to residents in regard to communications with resident family members.

Continues on LIC9099-C...
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 27-AS-20220110163907
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: WHITE HORSE HOME, INC.
FACILITY NUMBER: 347004223
VISIT DATE: 03/24/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Upon interview with Resident 1, R1 described in detail situations where R1 was told not to communicate with family regarding goings on at the facility. LPA observed R1 stating to S1 "do you remember when you got mad at me for telling RPR1 about all the facilities the company has". LPA observed S1 remaining silent and giving R1 no response.

In accordance with Title 22 Division 6 Chapter 1 Article 6 80072 (a) (1) this action is a violation of R1's personal rights. Therefore this portion of the allegations is substantiated.

Based on the witness statement, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided.

Exit interview was held and a copy of the report was given to the Licensee.
SUPERVISORS NAME: Stephen Richardson
LICENSING EVALUATOR NAME: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 27-AS-20220110163907
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: WHITE HORSE HOME, INC.
FACILITY NUMBER: 347004223
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2022
Section Cited
CCR
80072(a)(1)
1
2
3
4
5
6
7
(80072(a)(1) Personal Rights(a)...each client shall have personal rights which include, but are not limited to, the following:(1)To be accorded dignity in his/her personal relationships with staff and other persons.This requirement was not met as evidenced by..
1
2
3
4
5
6
7
Licensee stated they will provide training specific to resident personal rights and will submit a training sign in sheet by POC due date.
8
9
10
11
12
13
14
Based on interviews and observations,1 out 6 staff prevented R1 from communicating with R1's family. This poses a potential health and safety risk.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Jamie Ivey-Canady
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
LIC9099 (FAS) - (06/04)
Page: 7 of 7