405850094-3-25-2023-29-AS-KBUY-CQDW3U-20230329165630

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850094
Report Date: 03/25/2023
Date Signed: 03/25/2023 03:41:24 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
03/03/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20230303113407

FACILITY NAME:	ANGEL'S GROUP HOME		FACILITY NUMBER:	405850094
ADMINISTRATOR:	JUNSIK KIM		FACILITY TYPE:	735
ADDRESS:	2648 VINEYARD CIRCLE		TELEPHONE:	(805) 610-3676
CITY:	PASO ROBLES	STATE: CA	ZIP CODE:	93446
CAPACITY:	4	CENSUS: 4	DATE:	03/25/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator, Stephanie Salke		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff does not provide resident activities.
Facility staff go through residents' phones.

INVESTIGATION FINDINGS:

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At 11:30am on 03/25/2023, Licensing Program Analyst (LPA) Mark Jeffries arrived at the facility to issue final findings to the allegation above to this complaint. LPA introduced himself and announced the reason for the visit. LPA met with Administrator, Stephanie Salke.

As to the allegation, “Facility staff does not provide resident activities.” It was alleged there were no activities on the weekends. LPA reviewed activity schedule for the facility. Interviews revealed two of the clients go to work on the weekends, and two clients are at the home. Both clients who are at home on the weekends indicated sometimes they were not able to complete activities they wanted to due to staff. For example, one of the clients wants to go for walks, but the other client does not want to go on the walk. Activities schedule for January 2023 revealed activities done on weekends at the facility which included going to the park, lunch at Taco Bell, games, movies, birthday parties, made birthday cards, went to lunch, had barbecue, played games outside, walked, Starbucks, and drove to beach.
CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2023

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-20230303113407

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: ANGEL'S GROUP HOME	FACILITY NUMBER: 405850094
	VISIT DATE: 03/25/2023

NARRATIVE

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The activity schedule also indicated lots of bad weather that the region experienced, making some outdoor activities not possible. LPA provided technical assistance to the facility to incorporate a mix of at home and outside the activities, and be sure to include client’s feedback on activities they want to do. LPA also suggested that if two clients are at the facility on the weekend and only one wants to go on an outing, that client may be able to join activities at the licensee’s other facilities. Based on interviews and documentation there is not enough evidence at this time to support the allegation of, “Facility staff does not provide resident activities”, and is therefore, unsubstantiated at this time.

As to the allegation of, “Facility staff go through residents’ phones.” It was discovered through documentation and interviews conducted on 03/26/2023 of Staff 1 and 2 (S1, S2), and Clients 1, 2, 3, and 4 (C1, C2, C3, and C4), and interview conducted with Family member 1 (F1) on 03/17/2023, that there were two occurrences where staff had verbal and written permission to access client’s phone. On 05/18/2022, a written request was made by F1 who is the full conservator of C1, for staff to view, and identify unknown content from C1’s cell phone that created $1100+ phone bill on data used . S1 stated on or about the date of the letter from F1, S1 went through C1’s cell phone with C1 present. On 05/30/2022, C4, S2 and F4 had a meeting about internet and phone safety, at that meeting C4 gave verbal permission to S2 to go through C4’s phone and delete specific information from C4 phone, with C4 present. Interviews with all clients and staff conducted on 03/26/2023 did not indicate any other occurrences of staff going through residents’ phones. Based on the documentation of conservatorship dated November 26, 2013, incident report dated 05/30/2022 pertaining to C4’s internet and phone safety, C4’s admission to verbal consent, and interviews, the allegation of, “Facility staff goes through residents’ phones.” Is unsubstantiated, at this time.

Exit interview, report read, and report provided.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2023

LIC9099 (FAS) - (06/04)

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