425850081-5-23-2023-29-AS-KBUY-CSBU6Q-20230530151842

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 425850081
Report Date: 05/23/2023
Date Signed: 05/23/2023 01:39:59 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
02/09/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220209093820

FACILITY NAME:	STADIUM PLACE HOME		FACILITY NUMBER:	425850081
ADMINISTRATOR:	ASCALON, CLAIRE RN		FACILITY TYPE:	734
ADDRESS:	961 STADIUM PLACE		TELEPHONE:	(650) 580-8750
CITY:	SOLVANG	STATE: CA	ZIP CODE:	93463
CAPACITY:	5	CENSUS: 4	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Donna Pieprzycki, RN/Nurse Consultant		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Facility staff are not adequately trained.
Staff fed resident an inappropriate food item.
Facility does not conduct emergency drills.

INVESTIGATION FINDINGS:

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On 5/23/23 at 12:22 pm, Licensing Program Analyst (LPA) Chavez conducted an unannounced visit to deliver the final findings on the original complaint dated 2/09/22. LPA met with Donna Pieprzycki, RN/Nurse Consultant, and explained the purpose of the visit.

On the allegation, “Facility staff are not adequately trained,” the complainant’s concern was that the direct support providers are undertrained and that a client on a mechanical soft diet was fed fried chicken with bones and choked on the food. To investigate, LPA interviewed staff and witnesses, and reviewed records.

On 2/15/22, LPA interviewed staff. Staff comments include, “There was no instruction on how to prepare clients’ food. I have not received training on preparing mechanical soft food. We need more training,” and, “When I was first hired, I received training on preparing mechanical soft food, but I haven’t attended any other trainings, not any recently. There are Zoom meetings/trainings but not all staff attend, some are mandatory, some are not.” Continued on 9099-C.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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-20220209093820

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: STADIUM PLACE HOME	FACILITY NUMBER: 425850081
	VISIT DATE: 05/23/2023

NARRATIVE

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On 2/16/22, a credible witness states, “I believe new staff are not adequately trained.”

On 5/20/23, LPA reviewed training records. Records from March 2021 through February 2022 indicate that staff received training on food preparation on 6/3/2021 and 2/10/2022. LPA compared the facility’s current list of personnel and the food preparation trainings conducted on 6/3/21 and 2/10/22. In the 6/3/21 training, 7 out of 34 staff employed as of 2/14/22 received the meal preparation training. In the 2/10/22 training, 6 out of 34 staff received this training.

Based on the evidence obtained, the allegation, “Facility staff are not adequately trained,” is deemed Substantiated at this time. Deficiency cited.

On the allegation, “Staff fed resident an inappropriate food item,” the complainant’s concern was that staff fed Client #1 (C1), who requires a pureed diet, a full piece of fried chicken with bones in it, and the client choked on it and threw it up. To investigate, LPA interviewed staff and reviewed records.

On 2/15/22, LPA interviewed staff. Staff say that on one occasion, they fed C1 chicken and mashed potatoes. They say they prepared boneless fried chicken and that the breading was crispy on the edges. Staff say when C1 ate the mashed potatoes, there was no problem, however, when C1 ate the chicken, C1 choked on the chicken and vomited some of it up. Staff describes the pieces of chicken as “3-4 pieces, 4-5 inches long.” Staff also say that they served eggs and hashbrowns to C1, and C1 was “eating, not swallowing, then pushed away the food, began coughing, and threw up the food.” Staff say that C1 “shoves large portions of food in their mouth unless staff tell them otherwise.” Staff says they give C1 a full plate of food and chop the food into small bites” and that staff coach C1 on eating properly. Staff says that when they were first hired, they received training on preparing mechanical soft food, but since then says they have not attended any other trainings recently.

On 12/21/22, LPA reviewed the face sheet for C1 which indicates C1 has a “Regular pureed” diet. Staff say they use the face sheet as a resource to know how to care for clients.

Continued on 9099-C.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220209093820

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: STADIUM PLACE HOME	FACILITY NUMBER: 425850081
	VISIT DATE: 05/23/2023

NARRATIVE

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On 12/21/22, LPA interviewed Donna Pieprzycki, RN/Nurse Consultant. Consultant says she conducted training on 2/15/22 & 3/15/22 with staff on mechanical soft training and chopping up food properly in response to a staff’s concerns about C1 getting chicken that may have had bones or not chopped properly.

Based on the evidence, the allegation “Staff fed resident an inappropriate food item,” is deemed Substantiated at this time. Deficiency cited.

On the allegation, “Facility does not conduct emergency drills,” the complainant was concerned that staff have not received emergency fire or earthquake drills. To investigate, LPA interviewed staff and witnesses, and reviewed records.

On 2/15/22, LPA interviewed staff. Staff say, “I received new hire training, but there was no other training besides that and no evacuation drills,” and, “There have been evacuation drills, but they are inside the facility, not outside,” and, “There have not been any evacuation drills.”

On 5/20/23, LPA reviewed training records. Records show that the facility has documentation indicating that quarterly emergency disaster drills are being conducted, however, there are no names nor signatures showing which staff, if any, participated in the drills. The administrator’s signature is the sole name on the documentation.

Based on evidence obtained, the allegation, “Facility does not conduct emergency drills,” is deemed Substantiated at this time. Deficiency cited.

Exit interview conducted, deficiencies cited, and report and appeal rights given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220209093820

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: STADIUM PLACE HOME	FACILITY NUMBER: 425850081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/30/2023 Section Cited CCR 80065(a)	1 2 3 4 5 6 7	Personnel Requirements (a) Facility personnel shall be competent to provide...individual client needs and shall, at all times... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Nurse consultant has committed to have special dietary needs training by a RN and quarterly trainings on face sheets, physician’s orders. Consultant will send CCL by 5/30/23 a commitment stating these items will take place on an on-going basis.
	8 9 10 11 12 13 14	Based on interviews and record review, the above regulation was not met in that 6-7 staff out of 34 did not receive sufficient training on special dietary needs which poses a potential health and safety hazard to clients in care.	8 9 10 11 12 13 14
Type B 05/30/2023 Section Cited CCR 80076(6)(A)	1 2 3 4 5 6 7	Food Services (6) Modified diets prescribed by a client's physician...(A)The licensee shall obtain and follow instructions from the physician or dietitian on the preparation of the modified diet. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Nurse consultant has committed to have special dietary needs training by a RN and will conduct quarterly trainings on face sheets, physician’s orders, and diets. Consultant will send CCL by 5/30/23 a commitment stating these items will take place on an on-going basis.
	8 9 10 11 12 13 14	Based on interviews and record review, C1 has a regular pureed diet and was fed fried chicken by staff which C1 choked on and vomited which poses a potential health and safety hazard to clients in care.	8 9 10 11 12 13 14

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: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20220209093820

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: STADIUM PLACE HOME	FACILITY NUMBER: 425850081
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/23/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/30/2023 Section Cited HSC 1565(c)	1 2 3 4 5 6 7	Health & Safety Code (c) A facility shall conduct a drill at least quarterly...Documentation... the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Nurse consultant has committed to having emergency disaster training with documentation showing the date, the type of emergency covered by the drill, and, the names and signatures of staff participating in the drill. Consultant will send CCL this commitment by 5/30/23.
	8 9 10 11 12 13 14	Based on interviews and record review, the license did not meet the regulation cited above in that emergency disaster drills documentation does not include names of attendees which poses a potential health and safety issue to clients 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: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

Page: 5 of 7

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
02/09/2022 and conducted by Evaluator Darlene Chavez

COMPLAINT CONTROL NUMBER: 29-AS-20220209093820

FACILITY NAME:	STADIUM PLACE HOME		FACILITY NUMBER:	425850081
ADMINISTRATOR:	ASCALON, CLAIRE RN		FACILITY TYPE:	734
ADDRESS:	961 STADIUM PLACE		TELEPHONE:	(650) 580-8750
CITY:	SOLVANG	STATE: CA	ZIP CODE:	93463
CAPACITY:	5	CENSUS: 4	DATE:	05/23/2023
		UNANNOUNCED	TIME BEGAN:	12:22 PM
MET WITH:	Donna Pieprzycki, RN/Nurse Consultant		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff member made inappropriate comments to resident in care.
Facility does not provide residents an activity schedule.

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

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

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 29-AS-20220209093820

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: STADIUM PLACE HOME	FACILITY NUMBER: 425850081
	VISIT DATE: 05/23/2023

NARRATIVE

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On 2/15/22 between 12:05 pm and 1:04 pm, LPA interviewed staff. Staff comments include, “I have never witnessed rude comments from staff to clients, but staff are sometimes firm to get C1 to drink,” and “S1 can come across blunt and states their opinion but no negative words to clients,” and “S1 can come across as direct when working with C1,” and S1 says, “C1 can be grouchy, C1 doesn’t want to drink water. On one occasion where C1 wanted to drive, I told C1, ‘You can’t drive, you can’t get a license.’ I can be a bit pushy or direct but only to help clients, typically C1." On 2/16/22, a credible witness says they spoke with C1 about how staff treat C1, and C1 reports “they’re alright.”

Based on the evidence, the allegation, “Staff member made inappropriate comments to resident in care,” is deemed Unsubstantiated at this time. Staff interviews indicate S1 did not make inappropriate comments. However, a Technical Violation is being given due to interviews indicating that S1’s approach to clients has been observed as lacking in dignity at times.

On the allegation, “Facility does not provide clients an activity schedule,” the complainant’s concern was that an activity schedule is not in place for staff to provide activities for clients in care. To investigate, LPA interviewed the administrator and staff.

On 2/15/22, LPA interviewed the administrator who says that staff do not keep a schedule of activities, but that they have one-on-one activities with clients and says currently there is no adult day program for clients to attend. Administrator states activities are not documented, however, on 12/21/22, LPA observed photos and texts showing clients (3) at a pumpkin patch with staff. Administrator also states that in November 2022, staff took C1 to the zoo, and that staff take clients to the movies and the park and held a Christmas party in December 2022 for all clients of Stadium Place and Mountain Ridge.

On 2/16/22 at 4:50 pm, LPA spoke with a credible witness. The witness says they have seen staff take clients on outings in the community.

Based on the evidence obtained, the allegation, “Facility does not provide clients an activity schedule,” is deemed Unsubstantiated at this time.

Exit interview conducted and report given.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Darlene Chavez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2023

LIC9099 (FAS) - (06/04)

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