455002618-8-26-2022-25-AS-MSEY-CHRNS8-20220829104244

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002618
Report Date: 08/26/2022
Date Signed: 08/26/2022 10:48:28 AM

Unsubstantiated

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
06/23/2022 and conducted by Evaluator Misty Valencia

PUBLIC

COMPLAINT CONTROL NUMBER: 25-AS-20220623132607

FACILITY NAME:	DE MOLL HOME		FACILITY NUMBER:	455002618
ADMINISTRATOR:	VICTORINE, CHAYLENE		FACILITY TYPE:	735
ADDRESS:	1213 DE MOLL DRIVE		TELEPHONE:	(530) 410-9627
CITY:	REDDING	STATE: CA	ZIP CODE:	96002
CAPACITY:	4	CENSUS: 3	DATE:	08/26/2022
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Chaylene Victorine, Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff is not assisting client with personal care needs
Facility staff is not giving client medications as prescribed
Facility staff is leaving client unsupervised
Facility is not providing personal care supplies
Facility has a leaky roof resulting in damage to clients' personal items.

INVESTIGATION FINDINGS:

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On 08/24/2022, Licensing Program Analysts (LPAs) Misty Valencia and Rebecca Knight conducted an unannounced complaint investigation visit regarding the above allegation directed by the department. LPA met with Chaylene Victorine, Administrator explained the reason for the visit. Prior to initiating the visit, 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 Administrator and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95mask. Additionally, LPA was screened by staff at the front door.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2022

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-20220623132607

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: DE MOLL HOME	FACILITY NUMBER: 455002618
	VISIT DATE: 08/26/2022

NARRATIVE

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Facility staff is not assisting client with personal care needs
Facility is not providing personal care supplies
Facility staff is not giving client medications as prescribed
Facility staff is leaving client unsupervised
Facility has a leaky roof resulting in damage to clients' personal items.

The Department investigated the above allegations and during interviews with Administrator (Admin), three of three (3 of 3) staff, two of three (2 of 3) clients, one of three (1 of 3) is non-verbal, and reviewed records determined the above allegations are to be un-substantiated.

Facility staff is not assisting client with personal care needs

Facility is not providing personal care supplies

Interviews conducted with the Administrator (Admin), three of three (3/3) staff, and two of three (2/3) clients concluded that the facility staff has been assisting clients with their personal care needs and facility does provide personal care supplies. LPA toured the facility and observed a closet full of personal care items. All staff and clients who interviewed reported that they have never witnessed or heard about any issues regarding personal care allegations and get the assistance and supplies they need.

Facility staff is not giving client medications as prescribed

Interviews conducted with the Administrator (Admin), three of three (3/3) staff, and two of three (2/3) clients concluded that there are no concerns with medications. LPA reviewed records and observed that there were no medication errors within the facility for any of the clients in care.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 25-AS-20220623132607

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: DE MOLL HOME	FACILITY NUMBER: 455002618
	VISIT DATE: 08/26/2022

NARRATIVE

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Facility staff is leaving client unsupervised
Interviews conducted with the Administrator (Admin), three of three (3/3) staff, and two of three (2/3) clients concluded that they have never had any issues regarding being unsupervised. Staff reported that the facility is running twenty-four/seven 24/7 with night staff and none of the clients are left unsupervised. Two of three (2/3) clients interviewed reported that they have never been left alone.

Facility has a leaky roof resulting in damage to clients' personal items.

Interviews conducted with the Administrator (Admin), three of three (3/3) staff, and two of three (2/3) clients concluded that the facility has never had a leaky roof. LPA toured facility and facility seemed to be clean, sanitary and in good condition with no leaks in the roof. LPA did witness a room that is currently empty under remodeling due to a fish tank leak from a previous client, who no longer lives there. LPA reviewed records that report there were no leaks in the roof. The water damage on the floor was due to a leak in an old fish tank from a previous clients who no longer resides at the facility.

The preponderance of evidence standard has not been met. The allegations are Unsubstantiated.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and report emailed to Administrator.

SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Misty Valencia
LICENSING EVALUATOR SIGNATURE:	DATE: 08/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/23/2022

LIC9099 (FAS) - (06/04)

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