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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 397005824
Report Date: 03/25/2022
Date Signed: 03/25/2022 09:19:36 AM

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
03/08/2022 and conducted by Evaluator Bruce Jacobs
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20220308140734
FACILITY NAME:LINDEN GROVE ADULT RESIDENTIALFACILITY NUMBER:
397005824
ADMINISTRATOR:CAMPBELL, MARICA Z.FACILITY TYPE:
735
ADDRESS:21373 EASTERN HEIGHTS RDTELEPHONE:
(209) 430-8869
CITY:LINDENSTATE: CAZIP CODE:
95236
CAPACITY:6CENSUS: 5DATE:
03/25/2022
UNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ashley Strother, Facility ManagerTIME COMPLETED:
09:35 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained scratches and bruising in care as a results of neglect/lack of supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Facility Manager Ashley Strother to discuss and deliver investigation findings on the above allegation. This investigation consisted of site inspections to the facility to conduct interviews with the facility managers, staff and residents. Facility records were reviewed and copies of pertinent records obtained. Additional witnesses were contacted and interviewed.

All staff, residents and other witnesses interviewed denied that staff intentionally or through negelct had caused the injuries to the client (C-1). The client has an extensive history of self injurious behavior and the marks on the client were documented as such and reported to all parties as required. The client with the injuries is non-verbal and was not able to communicate how the injuries occurred.

Based on interviews, observations and record review it could not be proven with a preponderance of evidence that the client sustained scratches and bruising in care as a results of neglect/lack of supervision. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted and a copy of report provided

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Bruce Jacobs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022
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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