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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800130
Report Date: 12/24/2024
Date Signed: 12/24/2024 10:15:23 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, 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
01/18/2024 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20240118095524
FACILITY NAME:C.A.L.L.-RAMONA HOUSEFACILITY NUMBER:
405800130
ADMINISTRATOR:JAMI WESTFACILITY TYPE:
735
ADDRESS:3355 RAMONA ROADTELEPHONE:
(805) 466-2909
CITY:ATASCADEROSTATE: CAZIP CODE:
93422
CAPACITY:4CENSUS: 4DATE:
12/24/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Randyn TorresTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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9
Facility staff spoke inappropriately to client.
Facility staff did not follow needs and services plan.
Facility staff did not dispense medications as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) De Leon conducted a subsequent complaint visit to the facility to deliver final findings of the complaint allegations. LPA met with and explained the purpose of the visit.

LPA De Leon conducted the initial 10-day complaint visit on 01/24/2024 at 10:00am Resident Roster, Staff Roster with telephone numbers, Incident reports for 01/11/2024 and 01/14/2024, Staff Schedules from 11/2023-01/2024, Staff Training records for 2023-2024, Appraisal Needs and Services Plans for all 4 residents, Copy of MAR for R1, Copy of Medical visit for R2, Picture of R3's PRN Medication, MAR, and PRN information, interviewing staff at 10:30am, and delivering findings on 3 of the allegations.
LPA De Leon conducted additional interviews with staff on 02/23/2024 at 11:45am, on 12/05/2024 at 3:25pm and 3:50pm and on 12/09/2024 at 4:08pm.

Continued 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
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-20240118095524
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: C.A.L.L.-RAMONA HOUSE
FACILITY NUMBER: 405800130
VISIT DATE: 12/24/2024
NARRATIVE
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On the allegation: Facility staff spoke inappropriately to client. LPA De Leon interviewed 5/5 staff at the facility which revealed that no staff had spoken inappropriately to any of the 4 clients in care. The facility did not have any incident reports or staff disciplinary records on file to report any staff had spoken inappropriately to client. 4/5 staff interviews said during January-February 2024 staff 6 (S6) was having issues with new house supervisor staff 1 (S1), 6’s coming to work in a bad mood, not smiling, and at times sabotaging S1 from doing S1’s job as the house Supervisor, and it was never being taken out on the clients at the home. Staff 6 had been relocated to another facility within the C.A.L.L. program and then was eventually terminated from employment. S1 resigned from C.A.L.L. program on 02/20/2024. Due to the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff did not follow needs and services plan. LPA conducted interviews with 5/5 staff at the facility which revealed the facility has a time daily in staff schedules where staff are overlapped so the outgoing staff can communicate the client’s day to the incoming staff, the home has blinders on clients in care with all the information on the needs and services plan and all care plans are followed. Based on the lack of evidence this allegation is deemed Unsubstantiated at this time.

On the allegation: Facility staff did not dispense medications as prescribed. LPA interviewed 5/5 staff which revealed Staff 3 (S3) provided a prescribed PRN medication to Resident 1 (R1). LPA reviewed the client’s medication records and Resident 1 (R1) did have an order from a doctor for a PRN medication and the medication RX # 628396 with a Fill date of 08/22/2023 to go with the physician’s order. Based on the evidence this allegation is Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2