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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 425850135
Report Date: 08/01/2024
Date Signed: 08/27/2024 03:32:24 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
07/22/2024 and conducted by Evaluator Mark Jeffries
COMPLAINT CONTROL NUMBER: 29-AS-20240722162133
FACILITY NAME:REM CALIFORNIA LLC - CHURCHFACILITY NUMBER:
425850135
ADMINISTRATOR:SALAZAR, RAQUELFACILITY TYPE:
775
ADDRESS:305 WEST CHURCH STREETTELEPHONE:
(805) 349-7516
CITY:SANTA MARIASTATE: CAZIP CODE:
93458
CAPACITY:45CENSUS: 17DATE:
08/01/2024
UNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Administrator, Raquel SalazarTIME COMPLETED:
04:07 PM
ALLEGATION(S):
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Facility did not meet client's needs.
INVESTIGATION FINDINGS:
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 At 2:00pm on 08/01/2024, Licensing Program Analyst (LPA) Jeffries arrived unannounced to issue final findings to the allegation to this complaint. LPA met with Administrator, Raquel Salazar announced who he is and the reason for the visit.

As to the allegation of, “Facility did not meet client's needs.” It was alleged that Day Program Client 1 (C1) had been neglected by staff which resulted in C1 contracting Impetigo and having seizure. It was discovered through documentation, and interviews; on 07/29/2024 LPA Jeffries conducted interviews with Day Program Administrator, Raquel Salazar who stated that all clients maintain a minimum of 3 clients to 1 staff ratio. All staff are trained on current infection control regulations, and all staff are trained on seizure recognition, additionally, all staff had 1 hour of training on Impetigo infections. Administrator also stated that no staff or client has had a communicable infection in the past 12 months or more, apart from C1. On 07/31/2024,

CONTINUED on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
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-20240722162133
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 - CHURCH
FACILITY NUMBER: 425850135
VISIT DATE: 08/01/2024
NARRATIVE
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 LPA Jeffries reviewed documentation on training of Staff 13 of 13 staff having completed at least 1 hour of training on infection control on 08/20/2023 and 04/09/2024, Impetigo on 03/07/2024, and 12 of 13 staff have 1 hour of training on Seizures dated 07/05/2022 and 07/01/2024. On 07/31/2024. LPA Jeffries reviewed facilities infection control Plan as being current following regulations. LPA reviewed Incident Report submitted by day program on 07/11/2024 of C1’s seizure. LPA noted nothing abnormal about report indicating C1 fell during seizure and Emergency Services were called. There was no evidence that C1’s needs were not being met during this incident on 07/10/2024. On 08/01/2024, LPA conducted interviews of Staff 1-4 (S1, S2, S3, and S4). S1-4 all stated that the only infection they were aware of was of C1 in March and no other Clients in care. S1-4 all stated they had infection control training, Impetigo training and Seizure training within the last 12 months. S1 and S2 who were assigned staff to C1 on 07/10/2024 stated that they were less than 6 feet away from C1 during the incident on 07/10/2024 and had no way to support the fall of C1, as C1 fell without warning while walking. LPA Jeffries conducted an interview on 07/31/2024, with Family Member of C1 (F1) who stated that C1 returned from the hospital with no concussion, no history of seizure and cause of seizure was unknown according to the hospital release diagnosis. F1 suspected Impetigo, and seizure were a result of staff neglect but could not provided any further details on how or who C1 contracted Impetigo, or what that day program did that resulted in C1’s seizure. LPA Jeffries noted that C1 attended Day Program 3 time per week for a total of 6 hours per day for approximately 11 months. At this time there is not enough evidence to support the allegations that “facility did not meet C1’s needs” and is unsubstantiated at this time.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Mark Jeffries
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2