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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 392701332
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:29:19 PM

Substantiated


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
08/02/2024 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20240802111801
FACILITY NAME:CENTRAL VALLEY TRAINING CENTER STOCKTON EASTFACILITY NUMBER:
392701332
ADMINISTRATOR:PELLETIER, CANDICEFACILITY TYPE:
775
ADDRESS:7209 TAM O'SHANTER DRIVETELEPHONE:
(209) 490-4666
CITY:STOCKTONSTATE: CAZIP CODE:
95210
CAPACITY:150CENSUS: 120DATE:
08/08/2024
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jennifer JonesTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff member physically abused client in care
INVESTIGATION FINDINGS:
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On 8-8-24 at 2:00pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation noted above. LPA met with program designee Jennifer Jones and explained the purpose of the visit. During this investigation, LPA conducted interviews with staff1(S1), S2, and S3. LPA also reviewed incident report dated 7/11/2024 as well as employee file documentation for S4. Based on interview and record review, it was determined that on 7/10/2024 at approximately 11:00am, S4 engaged in inappropriate interaction with client1 (C1) in the classroom setting at the day program whicn included pinching C1's right forearm and elbow as an attempt to redirect C1 from an inappropriate behavior. C1 did not sustain injury as a result of incident. Based on interviews and record reviews, it was revealed C1 is no longer working with the clients at this day program. As a result, the preponderance of evidence standard is met, and this allegation is SUBSTANTIATED. Citation was issued under Title 22, Division 6. An exit interview was conducted with Jennifer Jones and a copy of this report was provided to Danielle. Appeal rights provided. LIC 811 provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
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-20240802111801
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: CENTRAL VALLEY TRAINING CENTER STOCKTON EAST
FACILITY NUMBER: 392701332
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/09/2024
Section Cited
CCR
82072(a)(3)
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82072 Personal Rights. (a) Each client shall have personal rights which include...(3)To be free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule... or other actions of a punitive nature...This requirement was not met as evidence by:
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Licensee will ensure completed staff training on resident rights and adult dependent abuse. Training date to be submitted to LPA by POC due date. Proof of completed training to be submitted to LPA by 8/24/24.
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Based on interviews and record reviews, Licensee did not ensure the above resident rights for C1 in that S4 engaged in pinching of C1's arm and elbow in an attempt for redirection. This posed an immediate health, safety, and resident rights risk to resident in care.
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Training on appropriate behavior interventions to be completed with proof of completion to be sent to LPA by 8/24/24.
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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: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC9099 (FAS) - (06/04)
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