425802138-12-4-2023-29-AS-KBUY-CYQ2Z4-20231220164944

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425802138
Report Date: 12/04/2023
Date Signed: 12/04/2023 04:17:00 PM

Substantiated

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
06/26/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230626150252

FACILITY NAME:	TELECARE AGNES AVENUE		FACILITY NUMBER:	425802138
ADMINISTRATOR:	CESAR ARGUETA		FACILITY TYPE:	772
ADDRESS:	116 AGNES AVENUE		TELEPHONE:	(805) 457-3724
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	10	CENSUS: 9	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Jessica Geihs, Administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility has inadequate hygiene supplies.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegation above. LPA obtained documents, interviewed staff on 7/26/23 at 3:14pm, 3:30pm, 4:28pm, and 5:55pm; 7/5/23 at 2:40pm, and 4:25pm; and 11/22/23 at 1:50pm and 2:01pm. LPA interviewed clients on 7/5/23 at 3:13pm. LPA met with Administrator and explained the purpose of the visit.

On the allegation: Facility has inadequate hygiene supplies. It was alleged that the facility was out of laundry detergent and toothpaste for 2 weeks. Interviews with staff and clients confirmed the facility did not have laundry pods for over 7 days and no one bought any. One client interviewed stated they had to wash sheets and clothes with no soap on the sanitize setting that took all day to try to get it clean. One staff stated they finally went to the other facility to pick up toothpaste until the shipment came. Based on the information obtained, the allegation is deemed Substantiated at this time.
Pursuant to Title 22 of the CA Code of Regulations, the following deficiency was cited (LIC 9099-D).
Exit interview conducted, copy of report and appeal rights issued.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

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-20230626150252

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: TELECARE AGNES AVENUE	FACILITY NUMBER: 425802138
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/04/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/11/2023 Section Cited CCR 81088(i)	1 2 3 4 5 6 7	81088 Fixtures, Furniture, Equipment, and Supplies (i) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to submit a plan to ensure supplies to not run out again and submit plan to CCL by 12/11/23.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above when the facility did not have laundry detergent or toothpaste for over 5 days, which posed a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
06/26/2023 and conducted by Evaluator Jeannette Olson

COMPLAINT CONTROL NUMBER: 29-AS-20230626150252

FACILITY NAME:	TELECARE AGNES AVENUE		FACILITY NUMBER:	425802138
ADMINISTRATOR:	CESAR ARGUETA		FACILITY TYPE:	772
ADDRESS:	116 AGNES AVENUE		TELEPHONE:	(805) 457-3724
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93458
CAPACITY:	10	CENSUS: 9	DATE:	12/04/2023
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Jessica Geihs, Administrator		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility has Insufficient Staffing.
Staff are not keeping accurate resident records.
Facility is not adequately assisting with medications.
Staff Violate Clients personal rights.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Olson conducted an unannounced subsequent complaint visit to issue final findings on the allegations above. LPA obtained documents, interviewed staff on 7/26/23 at 3:14pm, 3:30pm, 4:28pm, and 5:55pm; 7/5/23 at 2:40pm, and 4:25pm; and 11/22/23 at 1:50pm and 2:01pm. LPA interviewed clients on 7/5/23 at 3:13pm. LPA met with Administrator and explained the purpose of the visit.

On the allegation: Facility has Insufficient Staffing. It was alleged that due to unorganized schedule and lack of staffing the client to employee ratio is off and there is rarely a nurse on duty. Interviews reveal there is supposed to be 3 staff on shift but there is usually only 2, with a staff or two on call in case staff need extra support. Staff interviewed stated having 3 staff is nice when clients are in crisis and need extra support but 2 is usually sufficient. Staff stated that there were schedule issues earlier in the year but it’s been resolved. LPA interviewed clients who stated there are adequate staff to support them. Previous Administrator stated, “per our contract and staffing pattern, we are to have 2 direct service employees (either Residential Counselor or Peer) on every shift” as well as “a LVN/LVT nurse working M-F AM and PM”. (Contunied on 9099-A)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20230626150252

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: TELECARE AGNES AVENUE	FACILITY NUMBER: 425802138
	VISIT DATE: 12/04/2023

NARRATIVE

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LPA reviewed facility schedule from April 2023- July 2023 and observed one staff on shift for PM on 7/20/23, one staff on NOC on 7/21/23 and on staff AM for 7/22/23 and 7/23/23. Regulation 81065.5 states “there shall be at least one direct care staff person on duty, on the premises, any time clients are in the facility.” And “another direct care staff personal shall be on call and capable of responding within 30 minutes.” Administrator stated there are always Management available to respond to issues at a nearby facility in less then 30 minutes. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff are not keeping accurate resident records. It was alleged that clients medical documents are mixed with other clients medical documents. LPA interviewed staff who stated this used to be a problem a long time ago until they got a records person and it is not a problem. LPA reviewed resident documents and observed them to be organized and in individual folders. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Facility is not adequately assisting with medications. It was alleged that staff are not properly trained on how to pass medications and are only told to “watch a Relias Trainer video” but do not provide hands on the job training. LPA reviewed staff training and observed staff take a course called Medication Management for Unlicensed staff (med aides) which is a 60 minute course then shadow the nurse for around 2 hours prior to assisting with medications. LPA reviewed 4 clients medications on 10/03/2023 and observed medication to be properly documented and accounted for. Based on the information obtained, the allegation is deemed Unsubstantiated at this time.

On the allegation: Staff violate clients personal rights. It was alleged that staff racially profile African American clients, call the police and are much harsher with them versus Hispanic or white clients. It is also alleged that staff do not use the proper pronouns that clients want them to use. LPA interviewed Staff and Clients. Clients stated their rights were not violated and one client had been roommates with someone who asked to be called a (he/him) and the roommate said there were never any issues that they saw and staff tried to call the client by their preferred pronoun. Staff interviewed stated that Staff sometimes make pronoun mistakes but try their best to get it correct, it’s not deliberate. Staff also stated racially profiling happened earlier in the year but the person hasn’t been working since. This complaint allegation was already investigated on the 4/20/2023 complaint and the facility was cited for the violation of personal rights. The investigation for the current complaint did not reveal any evidence that staff acted inappropriately after the other complaint time period. Based on the information obtained, the allegation is deemed Unsubstantiated at this time. Exit interview conducted, copy of the report issued.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Jeannette Olson
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2023

LIC9099 (FAS) - (06/04)

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