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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 401700013
Report Date: 01/26/2022
Date Signed: 01/26/2022 05:38:11 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
01/07/2022 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20220107104707
FACILITY NAME:ATASCADERO CHRISTIAN HOMEFACILITY NUMBER:
401700013
ADMINISTRATOR:CHRIS WOHLWENDFACILITY TYPE:
740
ADDRESS:8455 SANTA ROSA ROADTELEPHONE:
(805) 466-0281
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:64CENSUS: 36DATE:
01/26/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Chris Wohlwend, AdministratorTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff are not wearing PPE accordingly
INVESTIGATION FINDINGS:
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On 1/26/2022, Licensing Program Analyst (LPA) Chavez conducted a 10-day complaint investigation. During the investigation, LPA interviewed the administrator regarding Complaint # 29-AS-20220107104707 and made observations.
At 11:45 am, LPA observed the administrator wearing an N95 mask that was falling down his nose. LPA questioned the administrator who stated that when he “talks, the mask falls down.” LPA mentioned that LPA Diaz visited on 1/12/22 and noted that the administrator’s mask was not being worn properly. LPA Chavez recollected that on a visit on 10/05/21, the administrator’s mask was also falling below his nose which LPA discussed with administrator. LPA asked the administrator if other personnel have not worn masks or done so improperly, and administrator stated he had a conversation recently with a staff who was working with a resident and not wearing a mask.
The facility failed to protect the personal rights of residents in care to be able to receive safe and healthful accommodations, in that the facility staff failed to wear face coverings properly while providing care and supervision to residents in care. This is a violation of official government orders requiring the wearing of face coverings while working under specified conditions.
Pursuant to Title 22, California Code of Regulations, the deficiency will be cited on 9099-D.
Exit interview conducted, deficiency cited, a copy of this report and appeal rights emailed to Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
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 29-AS-20220107104707
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/04/2022
Section Cited
CCR
87468.1
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87468.1 – Personal Rights of Residents in All Facilities

...To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidenced by:
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Administrator agreed to immediately get all staff trained on fit testing for N95 masks and provide training records with all staff signatures to CCL by 2/04/22.
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Based on observations, the facility failed to ensure staff were wearing face coverings which poses an immediate health, safety and personal rights risk to residents in care.
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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.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2