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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850134
Report Date: 03/06/2023
Date Signed: 03/06/2023 01:25:39 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
03/01/2023 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20230301142656
FACILITY NAME:REM CALIFORNIA LLC - LOMPOCFACILITY NUMBER:
425850134
ADMINISTRATOR:SMITH, RONICAFACILITY TYPE:
775
ADDRESS:1133 NORTH H STREET SUITE FTELEPHONE:
(805) 757-9595
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:45CENSUS: 12DATE:
03/06/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ronica Smith, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are smoking in the presence of clients
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA's) De Leon and Phillips conducted a 10 day complaint visit to the facility above on 03/06/2023. LPA's met with Administraor Ronica Smith at 9:50 AM and explained the purpose of the visit.

LPA's requested the following records:
Staff smoking policy, staff roster with telephone numbers, client roster, and any clients with smoking allergy. Administrator provide all records except their are no clients present with a smoking allergy that is known in the day program.

Continued 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
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 5
Control Number 29-AS-20230301142656
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: REM CALIFORNIA LLC - LOMPOC
FACILITY NUMBER: 425850134
VISIT DATE: 03/06/2023
NARRATIVE
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LPA's interviewed staff at 10:35am, 10:40am, 10:50am, 11:15am, 11:19am, 11:24 am, 11:34am and 11:43 am. LPA's interviewed clients at 11:50am, 11:55am, 12:05pm, and 12:10pm.

On the allegation: Staff are smoking in the presence of clients. LPA De Leon and Phillips interviewed staff and clients which revealed 6/8 staff stated a few of the staff smoke and a client usually follows them out to where they smoke. Two staff stated they smoke down wind from the clients in their presence. None of the staff were able to tell LPA's where the area specifically designated for smoking was located. Only 1 out of 4 clients stated the staff smoke out front of the building. LPA De Leon observed staff smoking in the parking space out the front of the building with a client in the van in the next parking space over. LPA De Leon observed another staff vaping right outside the front door next to the pillar on the walkway with no clients present. One client in particular follows staff outside when they smoke and staff have seen this. Based on the evidence this allegation is deemed Substantiated at this time.

Exit interview conducted, deficiency cited, copy of report and appeal rights printed and left with Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230301142656
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: REM CALIFORNIA LLC - LOMPOC
FACILITY NUMBER: 425850134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/13/2023
Section Cited
CCR
82072(a)(2)
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(a) Each client shall have personal rights which include, but are not limited to, the following:(a)...(2)To be accorded safe, healthful and comfortable
accommodations, furnishings and equipment to meet his/her needs. This requirement is met as evidence by:
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Administrator agreed to train all staff on designated smoking areas, appropriate smoking times and personal rights of clients 82072, provide copy of training,
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Based on staff/client interviews and LPA observation the licensee did not comply with the regulation above staff are in the presence of clients at times when smoking which poses a potential health, safety and personal rights risk to clients in care.
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facility sketch where smoking is designated with staff signatures to CCL.
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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: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/01/2023 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20230301142656

FACILITY NAME:REM CALIFORNIA LLC - LOMPOCFACILITY NUMBER:
425850134
ADMINISTRATOR:SMITH, RONICAFACILITY TYPE:
775
ADDRESS:1133 NORTH H STREET SUITE FTELEPHONE:
(805) 757-9595
CITY:LOMPOCSTATE: CAZIP CODE:
93436
CAPACITY:45CENSUS: 12DATE:
03/06/2023
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Ronica Smith, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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2
3
4
5
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7
8
9
Staff screamed at client
INVESTIGATION FINDINGS:
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2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst's (LPA's) De Leon and Phillips conducted a 10 day complaint visit to the facility above on 03/06/2023. LPA's met with Administraor Ronica Smith at 9:50 AM and explained the purpose of the visit.

LPA's requested the following records:
Staff smoking policy, staff roster with telephone numbers, client roster, and any clients with smoking allergy. Administrator provide all records except their are no clients present with a smoking allergy that is known in the day program.

Cotinued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230301142656
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: REM CALIFORNIA LLC - LOMPOC
FACILITY NUMBER: 425850134
VISIT DATE: 03/06/2023
NARRATIVE
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LPA's interviewed staff at 10:35am, 10:40am, 10:50am, 11:15am, 11:19am, 11:24 am, 11:34am and 11:43 am. LPA's interviewed clients at 11:50am, 11:55am, 12:05pm, and 12:10pm.

On the allegation: Staff screamed at client. LPA's conducted interviews with staff and clients, 1/8 staff interviewed revealed a staff member screamed at a client. 7/8 staff interviews stated they have never seen or heard of any staff ever scream at a client. 4 out of 4 clients stated the staff are nice, they like the program and no staff ever scream or yelled at them. Based on the evidence this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5