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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 401700013
Report Date: 03/29/2022
Date Signed: 03/29/2022 01:52:48 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
08/31/2020 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200831142337
FACILITY NAME:ATASCADERO CHRISTIAN HOMEFACILITY NUMBER:
401700013
ADMINISTRATOR:ROCIO BUSBYFACILITY TYPE:
740
ADDRESS:8455 SANTA ROSA ROADTELEPHONE:
(805) 466-0281
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:64CENSUS: 30DATE:
03/29/2022
UNANNOUNCEDTIME BEGAN:
01:23 PM
MET WITH:Chris Wohlwend, Administrator, and Jessica Guerrero, Health Services DirectorTIME COMPLETED:
02:05 PM
ALLEGATION(S):
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Food is not handled in a sanitary manner
Staff mismanaged resident's medications
The facility has insufficient staffing
Facility staff is not trained properly to handle medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Chavez conducted a subsequent complaint visit at the facility above to deliver final findings of the complaint allegations. LPA met with Administrator Chris Wohlwend and Jessica Guerrero, Health Services Director and explained the purpose of the visit.

LPA De Leon conducted the initial 10-day visit on 09/08/2020 from 12:30 PM to 3:53 PM toured facility grounds, requested documentation and interviewed staff. LPA De Leon conducted interviews with Residents on 09/09/2020 and 09/18/2020. LPA De Leon conducted interviews with staff on 09/08/2020, 09/10/2020, 09/14/2020, and 09/23/2020. LPA received and reviewed documentation on 09/08/2020, 09/09/2020, 09/13/2020 and 09/14/2020. LPA reviewed documentation on 03/29/2022 at 10:15 AM.

Continued on 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
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-20200831142337
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: 03/29/2022
NARRATIVE
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On the allegation: Food is not handled in a sanitary manner. LPA De Leon conducted interviews with residents and staff revealing all food was handled in a sanitary manner. Kitchen staff have current food handler certificates. Kitchen staff prepared all to go food orders in disposable containers and PCA staff would deliver them to go containers to each resident room while wearing masks, face shields, gloves and or utilizing hand sanitizer between each delivery. Based on the lack of evidence the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff mismanaged resident's medications. LPA interviewed 10 residents which all revealed they had no issues with medications or medication technician staff. The residents felt staff was trained adequately and had knowledge in and how to perform their jobs. Staff interviews did not reveal any issues with residents and medication, and there was no report of residents being given the wrong medication. The facility has not submitted any incident reports of mishandled medication during this time. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: The facility has insufficient staffing. LPA interviewed staff and residents which revealed the facility had fewer staff than scheduled at times due to call outs, staff quitting, staff getting fired and positive asymptomatic staff not being able to work during their isolation time. Staff interviews revealed staff are working 12-hour shifts voluntarily, staff are working hard and getting their jobs done to meet the resident’s needs. The resident interviews revealed staff are doing a great job meeting resident needs. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff is not trained properly to handle medications. LPA interviewed staff, residents and reviewed training documentation. Interviews revealed staff are trained for the jobs they perform, and some staff are crossed trained to help in other areas when needed. Medication technician staff have completed required trainings annually. Resident interviews revealed medication staff come to rooms regularly to deliver medications and none of the residents had any issues with medications or medication staffing. Based on the lack of evidence the allegation is deemed Unsubstantiated at this time.

Exit interview completed, no deficiencies cited, and copy of report emailed to Administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2