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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374602980
Report Date: 07/11/2023
Date Signed: 07/11/2023 04:56:00 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
07/05/2023 and conducted by Evaluator Esther Miller
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230705154431
FACILITY NAME:RUCKER FACILITYFACILITY NUMBER:
374602980
ADMINISTRATOR:LINDA RUCKERFACILITY TYPE:
735
ADDRESS:13662 POWERS RDTELEPHONE:
(619) 857-7144
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY:6CENSUS: 5DATE:
07/11/2023
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Linda Rucker, LicenseeTIME COMPLETED:
02:29 PM
ALLEGATION(S):
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Medication not given as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced visit to commence a complaint investigation. LPA was granted entry by Stephanie Wyatt, caregiver, after identifying herself. Linda Rucker, Licensee, arrived during the visit. LPA discussed the purpose of the visit and the basic elements of the allegation mentioned above with caregiver and Licensee. During today's visit, LPA interviewed staff and obtained records. At the end of the visit, LPA made a determination of findings and delivered them to Licensee.

On July 5, 2023, it was alleged that medication was not given as prescribed, specifically that a medication was never filled. The Department’s investigation consisted of review of facility records, LPA observations, and interviews with facility staff and outside sources.


[Continued on LIC9099-C, Page 1 of 2]
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
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-20230705154431
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: RUCKER FACILITY
FACILITY NUMBER: 374602980
VISIT DATE: 07/11/2023
NARRATIVE
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[Continued from LIC9099, Page 2 of 2]

Facility’s Medication Administration Record for Client 1 (C1) was reviewed. LPA observed that all C1’s medications were logged by staff as given June 2023. Review of physical medications revealed that one prescription was missing. Record review indicated the medication was prescribed in 2019. Licensee admitted to not filling medication due to medication being too expensive for C1. Licensee admitted to not attempting to find alternative solutions to get C1 the missing medication.

Based on the evidence obtained during the complaint investigation, the allegation that medication was not given as prescribed is found to be SUBSTANTIATED, as there is a preponderance of evidence to show that the violation occurred. Pursuant to the California Code of Regulations, Title 22, Division 6, deficiency is being cited on the attached LIC9099D and a plan of correction was jointly developed with Licensee. An exit interview was conducted with Licensee; a copy of this report and Licensee's Rights (LIC9058) were provided.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 08-AS-20230705154431
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: RUCKER FACILITY
FACILITY NUMBER: 374602980
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/11/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/11/2023
Section Cited
CCR
80070(a)
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80070 CLIENT RECORDS: (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client. This requirement is not met as evidenced by:
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Licensee provided proof of medication training that was completed on 07/04/2023 by staff who currently work in the facility. The deficiency was cleared during today's visit.
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Based on interview and record review, the licensee did not ensure complete records were maintained in 1 of 5 persons in care (C1) which poses a potential Health 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: Denise Powell
LICENSING EVALUATOR NAME: Esther Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 07/11/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3