425800283-9-26-2024-29-AS-KBUY-D9LSLD-20240930135811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425800283
Report Date: 09/26/2024
Date Signed: 09/26/2024 02:08:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
09/19/2024 and conducted by Evaluator Erika Miller

COMPLAINT CONTROL NUMBER: 29-AS-20240919093052

FACILITY NAME:	MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM		FACILITY NUMBER:	425800283
ADMINISTRATOR:	JUDY LINARES		FACILITY TYPE:	775
ADDRESS:	3070 SKYWAY DR STE 104 & 105		TELEPHONE:	(805) 566-9000
CITY:	SANTA MARIA	STATE:	ZIP CODE:	93455
CAPACITY:	105	CENSUS: 69	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Carry L. Andrade, Program Manager		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are violating resident's rights
Detergents, cleaners and poisons are not inaccessible to clients in care

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA), Erika Miller (Miller), conducted an unannounced initial complaint visit to the facility above on 9/26/24 and issued final finding on allegations above. LPA Miller was accompanied by Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QA) Vincent Figueroa (Figueroa). LPA Miller and QA Figueroa met with Carry L. Andrade (Andrade), program manager. LPA Miller toured the inside and outside of the facility. LPA Miller interviewed staff and residents.

Allegation: Staff are violating resident's rights
RP alleges that clients are required to participate in community outings. During a facility tour LPA observed Client 1 (C1) make an informal verbal request to go into the community tomorrow and Staff 1 (S1) was receptive to Client’s request. Staff advised that it is not rare for clients to make informal requests and staff will typically advise program managers of such requests.
(Continued on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240919093052

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: MOMENTUM WORK, INC. SANTA MARIA DAY PROGRAM	FACILITY NUMBER: 425800283
	VISIT DATE: 09/26/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

3 of 3 staff stated that clients may opt out of an activity and are offered and alternative activity. 3 of 3 staff stated that clients will be encouraged to participate or complete a work shift, but the client ultimately makes the decision to participate. Staff also stated there may be instances that they cannot accommodate a client request, due to weather.

Multiple clients stated that they enjoy working at day program and enjoy outings in the community. A client stated they could decline to participate in an outing and know who to advise. A different client stated that they are treated well by staff and that their requests are met. Client further stated that if they do not like something they can tell someone.

Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Detergents, cleaners, and poisons are not inaccessible to clients in care.

Reporting party (RP) alleges that chemicals and detergents are left unlocked and accessible to clients. On 9/26/24 at 11:00 am LPA observed that chemicals, detergents, and poisons were locked and inaccessible to clients in care in either a locked shed or locked janitorial closet. Staff stated that it would be highly unusual to leave the shed unlocked.

Although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

No deficiencies were issued. Exit interview conducted and a copy of the report printed for program manager.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2