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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392700130
Report Date: 02/15/2024
Date Signed: 03/04/2024 11:17:44 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH 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
10/17/2023 and conducted by Evaluator Arielle Pascua
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20231017083441
FACILITY NAME:SCHUMARD CARE HOME #2FACILITY NUMBER:
392700130
ADMINISTRATOR:DIZON, JESSICAFACILITY TYPE:
735
ADDRESS:4680 GLENBROOK DRIVETELEPHONE:
(510) 861-7497
CITY:TRACYSTATE: CAZIP CODE:
95377
CAPACITY:6CENSUS: 6DATE:
02/15/2024
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Debbie PeppyTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are not ensuring that resident's hygiene needs are being met
Staff are not ensuring that resident is appropriately dressed
Staff poured water on the floor as a form of deterrent for the resident
INVESTIGATION FINDINGS:
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On 02/15/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to conduct an complaint visit. LPA met with staff member, Debbie Peppy and explained the purpose of the visit. LPA asked that she call the Facility Designated Administrator to inform them that CCL was present at this time. LPA was able to speak with FDA, Jessica Dizon and was informed that she was unable to come to the facility however could finish and complete the visit with SM Peppy. An interview with FDA Dizon was conducted.
Current census was 6.

Allegation: Staff are not ensuring resident’s hygiene needs are being met
It was alleged that staff are not ensuring resident’s hygiene needs are being met. During the course of this investigation LPA reviewed facility records and conducted interviews. An interview with 3 staff were conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
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 2
Control Number 27-AS-20231017083441
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: SCHUMARD CARE HOME #2
FACILITY NUMBER: 392700130
VISIT DATE: 02/15/2024
NARRATIVE
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3 out 3 staff denied not being able to meet residents needs. 3 out 3 staff state that the resident has been needing a higher level of care due to their increased behavior. 3 out 3 staff members state that the resident’s conservator will come help the resident shower in the mornings to alleviate any hygiene needs. An interview with the resident’s service coordinator was conducted it was learned that the facility and the behaviorist have been working on prompting the resident to bathe everyday with staff, however, the resident’s conservator would like to continue showering the resident. A review of the resident’s behavior report states that the resident will often refuse to shower or bathe in the morning and the resident’s conservator will come help assist the resident with the resident’s hygiene needs. Based on the information gathered, it is unclear if the staff are not ensuring resident’s hygiene needs are being met.

Allegation: Staff are not ensuring that resident is appropriately dressed.

It was alleged that staff are not ensuring that the resident is appropriately dressed. During the course of this investigation LPA reviewed facility records and conducted interviews. An interview with 3 staff were conducted. 3 out 3 staff members denied not appropriately dressing the resident. 3 out 3 staff state that the resident will sometimes rearrange their clothing and will refuse cooperate to ensure that they have their proper clothing on. Based on facility records it was learned that the resident requires prompting and assistance to remain dressed as the resident is known to disrobe in common areas of the home or outside in public areas. Based on the information gathered, it is unclear if staff are not ensuring resident is appropriate dressed.

Allegation: Staff poured water on the floor as a form of deterrent for the resident

It was alleged that staff poured water on the floor as a form of deterrent for the resident. An interview with 3 staff members were conducted. 3 out 3 staff members deny pouring water on the floor as a form of deterrent. It was learned through these interviews that the resident came down stairs disrobed holding 2 water bottles where the resident dropped two water bottles and spilled it on themselves. A review of the facility records do not show any documentation that states that the resident is afraid of water at this time. Based on the information gathered, it is unclear if staff poured water on the floor as a form of deterrent for the resident.

As a result of this investigation, this Department found the allegations to be UNSUBSTANTIATED. A complaint allegation finding of Unsubstantiated meant that although the allegations may have happened or was valid, there was not a preponderance of the evidence to prove that the alleged violation occurred.



There were no deficiencies observed or cited at this time. An exit interview was conducted, a copy of the 9099 and 9099-C was provided to the facility.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2