397005824-12-19-2022-27-AS-KHOS-CMLRYX-20221230122703

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 397005824
Report Date: 12/19/2022
Date Signed: 12/19/2022 04:39:48 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
11/18/2022 and conducted by Evaluator Maja Jensen

COMPLAINT CONTROL NUMBER: 27-AS-20221118165025

FACILITY NAME:	LINDEN GROVE ADULT RESIDENTIAL		FACILITY NUMBER:	397005824
ADMINISTRATOR:	CAMPBELL, MARICA Z.		FACILITY TYPE:	735
ADDRESS:	21373 EASTERN HEIGHTS RD		TELEPHONE:	(209) 430-8869
CITY:	LINDEN	STATE: CA	ZIP CODE:	95236
CAPACITY:	6	CENSUS: 5	DATE:	12/19/2022
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Amber Thomas		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff physically assaulted resident(s) while in care.
Staff did not prevent smoking inside of the facility.
Staff did not prevent the usage of drugs inside of the facility.
Staff did not ensure that residents received a sufficient amount of food while in care.
Facility has pests.
Staff did not ensure that resident attended their doctor's appointment(s).
Staff did not allow resident to leave their room.
Staff did not allow resident to leave the facility.

INVESTIGATION FINDINGS:

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On 12/19/22 Licensing Program Analyst Maja Jensen arrived at facility to continue a complaint investigation in to the above listed allegations. Licensing Program Analyst Maja Jensen met with Amber Thomas and explained the purpose of today's visit.

LPA Jensen toured the facility including kitchen, living room, 3 staff bedrooms, game room, laundry room, front foyer, office and game room. The facility was observed to be sanitary and free of odor. There was no visible evidence of pest infestation. LPA Jensen observed in excess of a 2 day supply of perishable food and 7 day supply of non-perishable food. The facility staff was preparing pasta Alfredo with broccoli for dinner. LPA Jensen engaged with a resident that confirmed they did eat a snack today as well.

LPA Jensen interviewed or attempted to interview 3 residents. 2 residents are non-verbal.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

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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Control Number 27-AS-20221118165025

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: LINDEN GROVE ADULT RESIDENTIAL	FACILITY NUMBER: 397005824
	VISIT DATE: 12/19/2022

NARRATIVE

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Continued from LIC 9099....
LPA Jensen also reviewed a client sign out log. The log shows that visitors can sign clients out of the facility and must indicate where the client is going who the responsible party is, and when the expected time of return is. Staff also sign off on the time out and time in.

During the course of the investigation LPA Jensen toured and inspected the facility and grounds on 2 separate occasions. LPA Jensen also reviewed pest control logs and contract and the sign out log for clients.

LPA Jensen interviewed 4 staff members, a regional center staff member, 3 clients, and 3 responsible parties. LPA Jensen attempted to reach 2 additional responsible parties but was unsuccessful.

Staff physically assaulted residents in care
Based on interviews with clients, parties responsible for clients, staff and LPA Jensen's observations, this allegation is UNSUBSTANTIATED. All parties interviewed denied allegations of experiencing or having knowledge of any physical abuse. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff did not prevent smoking inside of the facility
Based on facility observations and interviews conducted, this allegation is UNSUBSTANTIATED. All parties questioned, denied the allegation of smoking inside the facility or having knowledge of anyone smoking in the facility. LPA Jensen was unable to detect any cigarette smoke odor in the facility and observed a well marked, dedicated smoking area for staff. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff did not prevent the usage of drugs inside of the facility
Based on facility observations and interviews conducted, this allegation is UNSUBSTANTIATED. All parties questioned, denied the allegation of drug use at the facility or having knowledge of anyone using drugs in the facility. LPA Jensen was unable to detect any cigarette smoke odor in the facility and observed a well marked, dedicated smoking area for staff. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 27-AS-20221118165025

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: LINDEN GROVE ADULT RESIDENTIAL	FACILITY NUMBER: 397005824
	VISIT DATE: 12/19/2022

NARRATIVE

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Continued from LIC 9099C...

Staff did not ensure that residents received a sufficient amount of food while in care
Based on interviews with clients, parties responsible for clients, staff and LPA Jensen's observations, this allegation is UNSUBSTANTIATED. All parties interviewed claimed there is enough food at the facility and LPA Jensen observed an adequate supply of food on 2 separate occasions at the facility. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Facility has pests
Based on interviews with clients, parties responsible for clients, staff, LPA Jensen's observations, and record reviews, this allegation is UNSUBSTANTIATED. The facility maintains a pest control service and has done so for at least the past 2 years. There was no visible evidence of pest infestation at the facility during the course of 2 site visits. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff did not ensure that resident attended their doctor's appointment(s)
Based on interviews with staff and responsible parties, clients are taken to doctor appointments therefore this allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Staff did not allow resident to leave their room
Based on interviews with staff, clients and LPA Jensen's observations this allegation is UNSUBSTANTIATED. All staff and clients interviewed denied the allegation that clients cannot leave their room. There are no locks on the doors. On 2 separate occasions during the course of a site visit, LPA Jensen observed all bedroom doors open unless a client was sleeping. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

Continued on LIC 9099C...

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20221118165025

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: LINDEN GROVE ADULT RESIDENTIAL	FACILITY NUMBER: 397005824
	VISIT DATE: 12/19/2022

NARRATIVE

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Continued from LIC 9099C...

Staff did not allow resident to leave the facility
Based on interviews conducted and records reviewed, all clients are allowed to leave the facility. Staff and clients confirmed that they go on outings. Responsible parties for clients also confirmed that clients are allowed to leave the facility. During the course of the investigation, there was at least one client that was on an extended outing with family. This allegation is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened, the preponderance of evidence does not prove it.

No deficiencies are being cited as a result of this investigation.

An exit interview was conducted and a copy of this report and appeal rights were given to Administrator Amber Thomas.

SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2022

LIC9099 (FAS) - (06/04)

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