425801987-11-18-2021-29-AS-KBUY-C92SWN-20211123131438

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425801987
Report Date: 11/18/2021
Date Signed: 11/18/2021 02:52:16 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
02/12/2021 and conducted by Evaluator Arien Diaz

COMPLAINT CONTROL NUMBER: 29-AS-20210212164345

FACILITY NAME:	UCP WORK, INC-ROSE		FACILITY NUMBER:	425801987
ADMINISTRATOR:	PAMELA HOLCOMBE		FACILITY TYPE:	735
ADDRESS:	434 E. ROSE AVENUE		TELEPHONE:	(805) 614-0967
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93454
CAPACITY:	4	CENSUS: 3	DATE:	11/18/2021
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Pam Holcombe		TIME COMPLETED:	11:10 AM

ALLEGATION(S):

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Residents are being mistreated while in care.
Staff did not treat resident with dignity.
Staff hit resident with an object.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Diaz conducted a complaint visit to deliver final findings of the complaint investigation conducted by LPA Diaz.

LPA Diaz reviewed facility documents and conducted interviews with staff and residents. LPA interviewed clients on 10/16/21 at 8:09pm and at 8:16pm. LPA interviewed clients on 10/28/21 at 3:00pm. LPA interviewed staff on 10/15/21 at 4:07pm and on 10/16/21 at 8:34am, and 9:29am. LPA interviewed staff on 10/17/21 at 3:48pm and at 5:05pm. On the allegation: residents are being mistreated while in care. 6 out 6 staff stated that they are unaware of clients being mistreated in the facility. According to the staff, the residents are comfortable expressing their concerns with the caregivers, but the caregivers have not been approached by clients regarding mistreatment. The staff members also stated they would report any client abuse to the Administrator.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Arien Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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-20210212164345

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: UCP WORK, INC-ROSE	FACILITY NUMBER: 425801987
	VISIT DATE: 11/18/2021

NARRATIVE

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The Administrator stated, clients and tenured staff will report observations or issues that occur in the facility, but nothing has been reported involving mistreatment. All staff stated that they have never seen or heard of any staff members being mistreated while in care. 3 out of 3 clients stated they are never mistreated by the staff int facility. Based on the interviews, on the allegation: residents are being mistreated while in care is deemed unsubstantiated at this time.

On the allegation: Staff did not treat resident with dignity. All staff stated that the residents are treated with dignity and staff members ensure residents are safe and their needs are being met. According the staff, caregivers are patient and speak to the clients politely. The caregivers are engaged with the clients, because they help cook, watch movies, and help guide or lead the clients. The staff stated that they are consistent but are never forceful with the clients. The caregivers never force the clients to do something they are unwilling to. The staff have observed their fellow staff members to treat clients with dignity and respect. 3 out of 3 clients stated, they are treated with dignity. According to the clients, the staff converse, watch movies, help cook, play tablet games and transport clients to the beauty salon. The clients stated that the staff are kind and the clients feel safe inside the facility. Based on the interviews, on the allegation: Staff did not treat resident with dignity is deemed unsubstantiated at this time.

On the allegation: Staff hit resident with an object. The staff members understand what a mandated reporter is. 6 out 6 staff stated they have never witnessed a staff member use an object to hit a resident but would immediately report it if they did. The Administrator stated that they are unaware of staff members hitting clients with objects. 3 out of 3 clients stated, the staff have never used objects in the facility to hit a resident. 1 out of 3 clients stated that clients throw objects inside the facility, but the staff do not use objects to hit clients. On the allegation: Staff hit resident with an object is deemed unsubstantiated at this time.

Exit interview, report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Arien Diaz
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC9099 (FAS) - (06/04)

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