397005196-10-5-2023-27-AS-KHOS-CWHSUK-20231011141113

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005196
Report Date: 10/05/2023
Date Signed: 10/05/2023 04:15:50 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/29/2023 and conducted by Evaluator Arielle Pascua

PUBLIC

COMPLAINT CONTROL NUMBER: 27-AS-20230829153557

FACILITY NAME:	APPLIED ABILITIES PROGRAM		FACILITY NUMBER:	397005196
ADMINISTRATOR:	LYNN HOGUE		FACILITY TYPE:	775
ADDRESS:	324 E. 11TH STREET., STE. C&D		TELEPHONE:	(209) 956-0290
CITY:	TRACY	STATE: CA	ZIP CODE:	95376
CAPACITY:	60	CENSUS: 30	DATE:	10/05/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Deirdre Murchison		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not ensure the clients records are current and maintained
Staff are not follow infection control practices

INVESTIGATION FINDINGS:

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On 10/05/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a complaint visit. LPA was greeted by Program Manager (PM) Deirdre Murchison and explained the purpose of the visit. The purpose of the visit was to deliver complaint findings for the allegations above.

Current census was 30. A brief interview with PM Murchison was conducted.

Allegation: Staff do not ensure the client records are current and maintained.
It was alleged that staff do not ensure that client records are current and maintained. During the course of this investigation, the LPA conducted interviews and reviewed facility records. Based on interviews conducted, it was found that the facility does not allow a resident to attend day program unless proper paperwork has been reviewed and completed. A review of 20 client records were conducted. LPA observed that 20 out of 20 client records were complete and up to date. It is unclear whether the staff did not ensure that the client records are current and maintained.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20230829153557

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: APPLIED ABILITIES PROGRAM	FACILITY NUMBER: 397005196
	VISIT DATE: 10/05/2023

NARRATIVE

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Based 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.

Allegation: Staff are not following infection control practices

It was alleged that staff are not following infection control practices. During the course of this investigation, the LPA conducted interviews and reviewed facility records. Based on interviews conducted, it was learned that the facility recently had a COVID-19 outbreak and had to shut down the facility for several days due to the continuous positive test results. Upon learning that multiple clients had COVID positive tests the facility sent all clients home and asked that staff get tested back at the facility. After testing, the facility did not conduct classes or have clients come in at this time, however, staff who were not positive were asked to ensure that proper COVID protocol was conducted which included calling client’s responsible parties, notifying Community Care Licensing and San Joaquin Public Health (SJPH). The facility ensured that prior to reopening the facility that all clients and staff members did not exhibit any symptoms or have been quarantined based on guidance from SJPH. In addition, the facility ensured that the facility was disinfected and cleaned by following the manufacturer’s instructions for proper use of the cleaning and disinfecting products. A review of the facility infection control plan was conducted. It is unclear if the facility did not following infection control practices.

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: Stephenie Doub
LICENSING EVALUATOR NAME: Arielle Pascua
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC9099 (FAS) - (06/04)

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