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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374601939
Report Date: 09/09/2022
Date Signed: 09/09/2022 01:49:39 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/02/2022 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20220302163034
FACILITY NAME:SPECIAL FRIENDS-SAGEWOODFACILITY NUMBER:
374601939
ADMINISTRATOR:WOJCIECHOWSKI, MICHELLEFACILITY TYPE:
735
ADDRESS:13411 SAGEWOOD DRIVETELEPHONE:
(858) 312-1687
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 6DATE:
09/09/2022
UNANNOUNCEDTIME BEGAN:
01:03 PM
MET WITH:Katherine Carver, House ManagerTIME COMPLETED:
02:07 PM
ALLEGATION(S):
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Staff verbally abused client.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced complaint investigation visit to the facility in order to deliver findings on the above allegation. LPA was granted entry to the facility by Virginia Pacheco, Caregiver, after identifying herself and explaining the reason for the visit.

On March 2, 2022, it was alleged that Staff 1 (S1 - see LIC811 Confidential Names) verbally abused a client. The Department’s investigation consisted of review of facility records, and interviews of facility staff and outside sources.

On March 2, 2022, it was alleged that S1, yelled and used profanity against Client 2 (C2). On March 4, 2022, the facility self-reported the incident to Community Care Licensing (CCL) involving the inappropriate staff interaction with C2. The incident report submitted stated that C2’s day program contacted the facility’s administrator to inform them of the incident between S1 and C2, and C2’s emotional response to the incident. The incident report also stated that an internal investigation into the allegation had started.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
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 08-AS-20220302163034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: SPECIAL FRIENDS-SAGEWOOD
FACILITY NUMBER: 374601939
VISIT DATE: 09/09/2022
NARRATIVE
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[Continued from LIC9099]

Outside source interviews and facility records showed that C2 had been a client of the facility from February 2, 2018 to March 15, 2022. After the incident with S1 on March 2, 2022, C2 temporarily moved to a sister facility until permanent placement could be made due to C2’s expressed unwillingness to stay in the facility with S1. C2 and C2’s responsible party had previously given notice to vacate in February 2022 due, in part, to frustrations with the care being provided by S1.

On March 9, 2022, Administrator Michelle Wojciechowski reported that Client 1 (C1) had told Administrator via text messages that S1 had yelled at them multiple times. The text messages ranged from November 2021 to February 2022. C1 had also told other sources that S1 had yelled at them; however, statements by outside sources revealed that C1 was known as an unreliable reporter, prone to exaggeration. Attempts to contact S1 for an interview were unsuccessful due to S1 not returning LPA’s phone calls.

Facility records revealed that S1 was hired at the facility in April 2021. Outside sources reported that S1 was witnessed speaking in a disrespectful manner to other providers and client’s family members. A 90 Day Review of S1's performance, date unknown, noted that S1 needed improvement with client care, interactions and activities, among other performance issues. Under client interactions and activities, the report indicated "The House Manager must interact with staff in a positive way. The residents see, hear and feel the interactions that staff has with the House Manager, which can make their lives more stressful if it is not a positive and respectful interaction." Facility records showed a Termination Letter given to S1 on March 21, 2022 resulting in S1 being dismissed from employment on March 25, 2022 due to overall unsatisfactory performance.

Based on the evidence obtained during the complaint investigation, the allegation that staff verbally abused clients is found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the allegation occurred. Pursuant to the California Health and Safety Code, Division 6 deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with House Manager. An exit interview was conducted with House Manager; a copy of this report and Licensee's Rights (LIC9058) were provided to House Manager.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20220302163034
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SPECIAL FRIENDS-SAGEWOOD
FACILITY NUMBER: 374601939
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/30/2022
Section Cited
CCR
80065(l)
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PERSONNEL REQUIREMENTS: 80065(l) Personnel shall provide for the care and safety of persons without … verbal abuse ... This requirement is not met as evidenced by:
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Administrator has been terminated since March 2022 and the Personnel Roster no longer reflects a current association. Administrator agreed to conduct in-service training regarding client's personal rights. Administrator agreed to submit training roster to LPA by POC date
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Based on interviews and record reviews, Staff 1 (S1) did not provide care without verbal abuse in two of six residents which posed a potential personal rights risk to residents 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: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/09/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3