455001755-10-13-2022-25-AS-TORZ-CKBUT9-20221018155135

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455001755
Report Date: 10/13/2022
Date Signed: 10/13/2022 10:49:28 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/17/2022 and conducted by Evaluator Rebecca Knight

COMPLAINT CONTROL NUMBER: 25-AS-20220617131948

FACILITY NAME:	BRAVO PROGRAM - ACCESS CENTER		FACILITY NUMBER:	455001755
ADMINISTRATOR:	ZIKAN, RODNEY		FACILITY TYPE:	775
ADDRESS:	9552 CROSSROADS DRIVE		TELEPHONE:	(530) 221-5251
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	15	CENSUS: 15	DATE:	10/13/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Fern Mayfield - administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Suspected abuse

INVESTIGATION FINDINGS:

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10/13/2022 10:00 AM Licensing Program Analyst (LPA) Rebecca Knight, made an unannounced visit to the facility and met with administrator Fern Mayfield. The purpose of this visit was to deliver the results of the complaint investigation of the above allegation. Prior to initiating the visit, LPA completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 Mask, gloves. In addition, LPA was screened by facility staff.

During the course of the investigation 2 administrators, 6 staff, and 1 client were interviewed. LPA obtained the following documents to investigate the above allegation: Physician’s report, Individual Program Plan, ER visit report, incident report, photograph of injury, staff list with telephone numbers.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

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 3

Control Number 25-AS-20220617131948

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BRAVO PROGRAM - ACCESS CENTER	FACILITY NUMBER: 455001755
	VISIT DATE: 10/13/2022

NARRATIVE

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Suspected abuse

It was alleged that Client 1 (C1) was a victim of suspected abuse while attending day program.

LPA review of documents included C1’s Individual Program Plan (IPP) dated 2/28/2022 states: Safety supports needed: C1 requires constant supervision as they lack safety awareness and is at high risk for potential injury. C1 requires someone nearby in all settings to prevent injuries.

3 of 3 day program staff stated that C1 did not complain of pain, C1 did not tell staff that someone had hurt them, C1 did not indicate that they were injured, staff did not witness C1 being abused or injured while attending program.

3 of 3 facility staff stated C1 did not complain of pain, 3 of 3 staff stated they did not witness C1 being abused, 3 of 3 staff stated they do not know how C1 sustained the injury.

During interview of client C1 did not indicate they were abused by anyone nor state how the injury occurred.

Administrator of the day program stated C1 did not indicate that anyone had hurt them or indicate they were in any pain while attending program. Administrator stated they did not witness C1 being abused or injured while attending program.

Administrator of the facility that C1 resides in stated C1 was showered the morning before they went to day program and there was no bruising observed at that time. The injury was discovered when C1 was showered that night, and administrator took C1 to the local ER for examination where C1 was diagnosed with hematoma and swelling. C1 did not complain of being in pain, C1 did not say anything about it when they returned home from program. Administrator did not witness C1 being abused by anyone, C1 did not tell the administrator they were abused by anyone.

Continued on LIC9099-C

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20220617131948

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: BRAVO PROGRAM - ACCESS CENTER	FACILITY NUMBER: 455001755
	VISIT DATE: 10/13/2022

NARRATIVE

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Based on LPA interviews, and record review it was determined that while C1 did sustain an injury, there was no evidence of abuse discovered therefore the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are UNSUBSTANTIATED.

An exit interview was conducted. A copy of the report was emailed to facility administrator Fern Mayfield. No deficiencies were cited on today’s date.

SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Rebecca Knight
LICENSING EVALUATOR SIGNATURE:	DATE: 10/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2022

LIC9099 (FAS) - (06/04)

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