361800232-6-2-2022-56-AS-NBRN-D2VRUQ-20240228122019

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800232
Report Date: 06/02/2022
Date Signed: 06/02/2022 02:47:00 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/26/2022 and conducted by Evaluator Rohit Lama

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20220526084704

FACILITY NAME:	SKY BLUE SUMMER CARE		FACILITY NUMBER:	361800232
ADMINISTRATOR:	WALKER, CLAUDIA		FACILITY TYPE:	735
ADDRESS:	16410 NISQUALLI RD		TELEPHONE:	(760) 596-1659
CITY:	VICTORVILLE	STATE: CA	ZIP CODE:	92395
CAPACITY:	4	CENSUS: 4	DATE:	06/02/2022
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Licensee, Claudia Walker		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff not meeting resident's needs due to inadequate staffing.
Staff are verbally abusive to residents while in care.
Staff are mismanaging resident's medications.
Facility has inadequate food supply.
Facility does not provide activities for residents.
Night staff sleeps durings shifts.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rohit Lama conducted an unannounced visit to initiate a complaint investigation and deliver the findings for the allegations listed above. LPA met with Licensee, Caluadia Walker. Before granting access, Staff #1 (S1) required LPA to sign in and ensured that LPA was masked.

In regards to the allegations listed above, LPA Lama made observations, reviewed records, and interviewed three residents: Resident #1 (R1), Resident #2 (R2), and Resident #3 (R3). R3 is nonverbal and was able to only provide head nods (for agreement) and head shakes (for disagreement) for the questions that were asked

The frist allegation states that there are not enough staff members to meet the needs of the clients. LPA Lama interviewed three residents: Residents R1, R2, and R3 confirmed that staff is able to meet there needs. R1 and R2 stated they do not feel that there needs to be more staff. R3 was unable to provide an adequate response. ***CONTINUED ON LIC 809-C***

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

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 3

Control Number 56-AS-20220526084704

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: SKY BLUE SUMMER CARE	FACILITY NUMBER: 361800232
	VISIT DATE: 06/02/2022

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

***CONTINUED FROM LIC 809***

LPA asked R1 and R2 if they felt that other clients' needs were not being met. R1 and R2 stated no.

The second allegation states that staff are verbally abusive to residents. LPA Lama asked R1 and R2 if they have ever been verbally abused by staff. R1 and R2 stated no. LPA asked if they have ever heard staff abusing any of the other clients. R1 and R2 stated no. LPA asked R3 if he/she has ever been verbally abused. R3 did not provide a response. LPA asked R3 if staff is mean to him/her. R3 shook head in disagreement.

The third allegation states that staff are not handling medications appropriately and thus clients are not able to get medications appropriately. LPA asked R1, R2, and R3 if they get their medications on time on a daily basis. R1, R2, and R3 all agreed. LPA asked them if they have ever missed medications. R1, R2, and R3 stated no or shook their head in disagreement. LPA also inspected the medications that are kept locked in a filing cabinet. The medication was all present in adequate quantities and additional medications were delivered while LPA was present. LPA also noted that all the medications from the "Blister packs" had been dispensed appropriately.

The fourth allegation states that food is not present in adequate quantities. LPA asked R1, R2, and R3 if they are fed on a daily basis. R1, R2, and R3 agreed. LPA also inspected the food supplies. LPA noted that food was present in adequate quantities. There were more than 2 days of perishable foods and more than 7 days of non-perishable foods available for the residents.

The fifth allegation states that the facility does not provide activities for the residents. LPA Lama asked R1 and R2 if the facility provides activities. R1 and R2 stated that they often go out shopping, go to the park, or occasionally go out for meals together. R3 was unable to provide an answer. LPA Lama asked R3 if they go out to places together. R3 nodded his/her head.

The sixth allegation states that the night staff sleeps at night. LPA asked R1 and R2 if staff is available to help them at night. R1 and R2 stated that staff is always available. LPA asked if there ever was an instance that they needed help and staff was not available. R1 and R2 said no. ***CONTINUED ON LIC 809-C***

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 56-AS-20220526084704

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: SKY BLUE SUMMER CARE	FACILITY NUMBER: 361800232
	VISIT DATE: 06/02/2022

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

***CONTINUED FROM LIC 809-C***

LPA asked R3 if staff helps him/her when he/she needs it. R3 nodded in agreement. LPA also reviewed the staff schedule. LPA noted that there is always a staff member scheduled during the night shift. LPA asked the Licensee what were to happen if a staff member were to call out. Licensee stated that one of the other staff members would work a double or that she would come in to cover that shift herself.

Based on the information obtained there is not enough evidence that the above mentioned allegations occurred. Therefore, the allegations are deemed Unsubstantiated at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated. No deficiencies are being cited at this time.

LPA conducted an exit interview where this report was discussed with the Licensee. A copy of this report was was provided to the Licensee at the conclusion of this investigation.

SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Rohit Lama
LICENSING EVALUATOR SIGNATURE:	DATE: 06/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/02/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3