401700013-10-14-2020-29-AS-KBUY-BUDUX5-20201014155746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 401700013
Report Date: 10/14/2020
Date Signed: 10/14/2020 02:17:41 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2020 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20200911141033

FACILITY NAME:	ATASCADERO CHRISTIAN HOME		FACILITY NUMBER:	401700013
ADMINISTRATOR:	ROCIO BUSBY		FACILITY TYPE:	740
ADDRESS:	8455 SANTA ROSA ROAD		TELEPHONE:	(805) 466-0281
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	64	CENSUS: 48	DATE:	10/14/2020
		UNANNOUNCED	TIME BEGAN:	02:04 PM
MET WITH:	Rocio Busby, Administrator		TIME COMPLETED:	02:19 PM

ALLEGATION(S):

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Conduct Inimical
Administrator failed to follow public health orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rachael De Leon conducted a subsequent complaint visit to deliver final findings of the investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted by telephonic video with Administrator Rocio Busby. LPA explained the purpose of the visit to the Administrator.

On the allegation: Conduct Inimical, LPA interviewed 6 facility staff, 10 residents and 1 expert witness during the investigation. None of the interviews revealed conduct inimical by the facility administrator or staff at the facility. Interviews with 4 out of 6 staff revealed never seeing Covid-19 positives staff on grounds during their isolation periods, those

Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

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 29-AS-20200911141033

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATASCADERO CHRISTIAN HOME	FACILITY NUMBER: 401700013
	VISIT DATE: 10/14/2020

NARRATIVE

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staff were never told not wear masks at the facility and those 4 staff never heard the administrator or any management tell any other staff that they didn’t have to wear masks at the facility. Interviews with 1 of 6 staff revealed a staff that was positive for covid-19 and was put on home isolation did go on the facility grounds the next day to collect important paperwork to conduct required business that needed to be handled, no contact was made with anyone as far as they were aware. Interview with 1 out of 6 staff revealed staff did go on grounds to collect needed work from the office, the staff member wore an N95 mask and stayed 100-300 yards away from all residents and staff at the facility, the staff was on grounds for less than 15 minutes, collected items needed and left without any close contact with anyone. Interviews with 10 out of 10 residents revealed all staff wear masks and no one saw any Positive Covid-19 staff on facility grounds during their isolation period. An Expert Witness was consulted, and the witness statement revealed it was not a concern and it was not a violation of the public health order if the staff was masked and did not have contact with anyone. Based on the investigation conducted in this case the allegation is deemed Unsubstantiated at this time.

On the allegation: Administrator failed to follow public health orders, LPA interviewed 6 staff, 10 residents and 1 expert witness. In 16 out of 16 interviews with staff and residents nothing was revealed to show any violation of public health orders occurred by the Administrator and interviews all show the staff does follow public health orders when it comes to masks and full personal protective equipment when dealing with Covid-19+ residents in the facility. An Expert Witness was consulted and based on the information provided it was not a concern and it was not a violation of the public health order. Based on the investigation conducted the allegation is deemed Unsubstantiated at this time.

Exit interview conducted on a telephonic video call with Administrator, copy of report will be emailed to the Administrator for signature, administrator will sign report and return report to the LPA by mail to the Goleta office.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 10/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2020

LIC9099 (FAS) - (06/04)

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