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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 455002559
Report Date: 03/10/2022
Date Signed: 03/10/2022 09:37:42 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/14/2022 and conducted by Evaluator Misty Valencia
PUBLIC
COMPLAINT CONTROL NUMBER: 25-AS-20220214162758
FACILITY NAME:OAK MESA HOMEFACILITY NUMBER:
455002559
ADMINISTRATOR:BAUGHMAN, LINDSAYFACILITY TYPE:
735
ADDRESS:1870 OAK MESATELEPHONE:
(530) 215-3973
CITY:REDDINGSTATE: CAZIP CODE:
96003
CAPACITY:6CENSUS: 4DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jaquie Stevens, Direct Support Professional (DSP)TIME COMPLETED:
10:00 AM
ALLEGATION(S):
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A staff person was working and was intoxicated while at the facility.
INVESTIGATION FINDINGS:
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On 03/10/2022Licensing Program Analysts (LPAs) Misty Valencia arrived at the facility to conduct an unannounced complaint investigation visit to deliver findings regarding complaint. LPA met Jaquie Stevens, Direct Support Professional (DSP) and explained the reason for the visit. Prior to visits LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted licensee and completed a facility risk assessment. LPAs ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical Mask, Additionally, LPA was screened by facility staff at the front door.

Continuation on LIC 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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-20220214162758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME: OAK MESA HOME
FACILITY NUMBER: 455002559
VISIT DATE: 03/10/2022
NARRATIVE
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Allegation: A staff person was working and was intoxicated while at the facility.

Based on statements received and records reviewed, LPA investigated allegation and determined that S1 and S2 were both intoxicated while working at the facility substantiated. Administrator reported that both S1 and S2 no longer work at the facility and were terminated for being intoxicated while at work. They were the only staff on shift at that time. S1 and S2 were found by the oncoming NOC shift staff 3 (S3) on 02/11/2022 at approximately 1146pm, outside the facility gate intoxicated and not supervising clients during their shift. S3 reported that she could smell the scent of alcohol on S2’s breath through her N95 mask. Police report confirmed that both staff members were drinking on the job. Police report confirmed that S1 was transported, by friends to the hospital due to alcohol poisoning. Administrator confirmed that alcohol and drugs are not allowed at the facility.

Based on information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Administrative actions may occur.

Exit interview completed and two copies for LIC 9099/C/D were provided via e-mail. LPA requested for a signed copy to be returned via e-mail.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 25-AS-20220214162758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: OAK MESA HOME
FACILITY NUMBER: 455002559
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2022
Section Cited
HSC
80065(l)
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 ***AMENDED***
80065 Personnel Requirements (l) Personnel shall provide for the care and safety of persons without physical or verbal abuse, exploitation or prejudice.This requirement is not met as evidenced by: Based on interviews and records reviewed, the licensee did not ensure that
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 ***AMENDED***
Licensee agrees to hold in-service training with all staff to review the facility's drug and alcohol policy. Submit sign-in sheet and written confirmation of training completion to CCL by 03/11/2022 date to clear the deficiency
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 ***AMENDED***
S1 and S2 were not under the influence of drugs and/or alcohol while at work. Although,they are no longer present in the facility, they were not competent to provide care and supervision to the residents. This poses an immediate health and safety risk to residents in care.
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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: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3