435202592-2-16-2023-26-AS-KHOS-CRFH5G-20230502055331

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202592
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:46:04 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2023 and conducted by Evaluator Ryker Heberle

COMPLAINT CONTROL NUMBER: 26-AS-20230206164806

FACILITY NAME:	FOOTHILL ADULT RESIDENTIAL FACILITY		FACILITY NUMBER:	435202592
ADMINISTRATOR:	ANGELICA ATRIANO		FACILITY TYPE:	735
ADDRESS:	13655 FOOTHILL AVE		TELEPHONE:	(669) 231-3861
CITY:	SAN MARTIN	STATE: CA	ZIP CODE:	95046
CAPACITY:	4	CENSUS: 3	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	01:01 PM
MET WITH:	Angelina Atriano		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Facility leaves chemicals unsecured from residents
Staff are using drugs at the facility
Staff is asleep during night shifts

INVESTIGATION FINDINGS:

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Licensing Program Analyst Ryker Heberle (LPA) arrived at the facility to conduct an unannounced complaint investigation regarding the above allegations. LPA met with facility Administrator Angelica Atriano (Admin).

LPA toured the facility, interviewed 3 staff members and 3 residents, and reviewed the following documentation: 3 resident sleeping logs, noct shift responsibility logs dating back to 1/1/2023, and staff training on illicit substances.

LPA toured the whole facility including 3 bathrooms, 3 resident bedrooms, kitchen, office, activity room, garage, and backyard. During tour of the facility, LPA observed all chemicles locked away in cabinets in the laundry room and garage. LPA did not observe any chemicles in readily accessible areas.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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 26-AS-20230206164806

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131

FACILITY NAME: FOOTHILL ADULT RESIDENTIAL FACILITY	FACILITY NUMBER: 435202592
	VISIT DATE: 02/16/2023

NARRATIVE

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During interviews with Administrator, Admin stated that there had been a staff member that had been caught sleeping on the job in 2021 during the day shift. They were written up at the time, and have since transferred to a separate facility. In interviews with 2 additional staff members and 3 residents. 4 out of 5 individuals interviewed stated that the had not ever witnessed staff fall asleep on the job. 1 out of 4 individuals interviewed stated that they had not witnessed any staff members sleeping since the incident that occurred in 2021.

LPA reviewed resident sleeping logs. Sleeping logs show all 3 residents as having been checked on at least once per hour from January 20th 2023 to present. 1 out of 3 residents had been checked in on once every 15 minutes. Resident sleeping logs are at moment of staff check in.

LPA interviewed 3 staff and 3 residents regarding staff drug use. 3 out of 3 staff interviewed and 3 out of 3 residents interviewed had not observed staff members using drugs or alcohol at any point during their time at the facility. During tour of the facility, LPA did not observe a noticeable odor nor any drug paraphernalia on the facility premises. LPA reviewed facility illicit substance policy, which indicated that staff members are turned away from the facility at any signs of inebriation. Substance Abuse policy was observed to have been signed by all staff members currently working at the facility.

This Department has investigated the above allegations, and based on records review, interviews and observation, the Department has determined that the allegations were Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

Exit interview conducted. This report was reviewed with Administrator Angelica Atriano and a copy was provided.

SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Ryker Heberle
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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