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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405800577
Report Date: 08/04/2022
Date Signed: 08/04/2022 04:12:00 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, 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
09/23/2020 and conducted by Evaluator Darlene Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200923102912
FACILITY NAME:VILLAGE AT SYDNEY CREEK, THEFACILITY NUMBER:
405800577
ADMINISTRATOR:KIRK P KOTTHORFACILITY TYPE:
740
ADDRESS:1234 LAUREL LANETELEPHONE:
(805) 543-2350
CITY:SAN LUIS OBISPOSTATE: CAZIP CODE:
93401
CAPACITY:84CENSUS: 43DATE:
08/04/2022
UNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Kirk Klotthor, Executive Director/AdministratorTIME COMPLETED:
04:23 PM
ALLEGATION(S):
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Facility Administrator is not at the facility a sufficient number of hours.
INVESTIGATION FINDINGS:
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On 8/4/22022 at 11:05 am, Licensing Program Analyst (LPA) Darlene Chavez conducted an unannounced complaint investigation visit to the facility listed above. LPA met with Kirk Klotthor, Executive Director/Administrator and explained the purpose of the visit.

On the allegation “Facility Administrator is not at the facility a sufficient number of hours,” the complainant’s concern was that the facility administrator is at the facility about 16-20 hours per week and is typically out of the building running personal errands. To investigate the allegation, LPA interviewed the administrator and staff.
On 9/25/20 at 2:59 pm, LPA interviewed Kirk Klotthor. Administrator states that he works at Village at Sydney Creek full days on Mondays and Wednesdays and four hours on Fridays, then works at Garden Creek full days on Tuesdays and Thursdays and four hours on Fridays. He said sometimes his schedule changes “depending on what comes up.” He explains that the other administrator, Heather Chapman, is an on-call employee and that Laura Green, Life Enrichment Director, works Saturdays.
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: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
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-20200923102912
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: VILLAGE AT SYDNEY CREEK, THE
FACILITY NUMBER: 405800577
VISIT DATE: 08/04/2022
NARRATIVE
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On 12/22/20 at 11:53 am, LPA interviewed Staff #6 (S6), a management employee. S6 states that the administrator and wellness coordinate are not available on weekends. S6 says the LVN is the possible back-up on weekends; however, S6 believes “there is a lack of supervision.” S6 recalls a time when the Vice President of The Villages showed-up for a meeting with the administrator and waited 35-40 minutes for him to arrive.

On 7/21/22 between 1:34 pm and 2:59 pm, LPA interviewed three staff. Staff #1 (S1) says that “Every other day he goes to Garden Creek or as needed when there’s a problem. He’s reachable. Even on weekends, he’ll answer maybe just a little later.” Staff #2 (S2) says “If his office is open, he is here.” S2 says they do not see the administrator in the afternoon. S2 voices “He needs to be here to know what’s going on, that we need more staff.” S2 further states that it would be better if he was here all the time, and not split between Sydney Creek and Garden Creek. Staff #3 (S3) states that they do not see the administrator very often because S3 works in the facility’s neighborhoods and don’t spend much time outside the neighborhoods. S3 says they “saw Kirk about one to two times per week. I knew he was the executive director, but didn’t know him and only spoke to him a couple of times.” Staff #4 (S4) says they don’t notice the hours the administrator is in the building. Staff #5 (S5) says “If he’s not here, he answers his phone, he calls or texts. The only time he’s not available is when he’s on vacation.” S5 explains that “The facility has a strong, capable management team who works really well together and would be strong regardless of whether Kirk was the Executive Director or not.”



Based on the evidence obtained, the allegation ““Facility Administrator is not at the facility a sufficient number of hours,” is deemed Unsubstantiated at this time. The administrator appears to be in the facility at minimum the required hours. However, based on staff comments, there is evidence to suggest the facility administrator should be in the building more hours to properly communicate with staff on the facility’s needs. Technical assistance is being given to educate on the requirement for administrator hours.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2