455002659-8-28-2024-59-AS-KHOS-D8SLKV-20240904085010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455002659
Report Date: 08/28/2024
Date Signed: 08/28/2024 03:32:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/29/2024 and conducted by Evaluator Sarah Benson

COMPLAINT CONTROL NUMBER: 59-AS-20240329145136

FACILITY NAME:	CAZADERO HOME, INC		FACILITY NUMBER:	455002659
ADMINISTRATOR:	OSTERMAN, RUSSELL		FACILITY TYPE:	735
ADDRESS:	3556 CAZADERO WAY		TELEPHONE:	(530) 262-5002
CITY:	ANDERSON	STATE: CA	ZIP CODE:	96007
CAPACITY:	6	CENSUS: 4	DATE:	08/28/2024
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Angel Doss Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff is withholding medications to client(s).
Staff if locking client in client's room for hours.
Staff is not assisting client with incontinent care.
Staff are not providing the necessary supervision to prevent other clients from assaulting client.

INVESTIGATION FINDINGS:

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On 8-28-24, Licensing Program Analyst (LPA) Sarah Benson arrived at the facility unannounced to deliver final findings regarding a complaint that was received on 03/29/24. LPA Benson met with Angel Doss, Administrator, and explained the purpose of the visit.

During the interview process, four staff persons and two clients were interviewed. The following documents were received and reviewed: Client and staff list with telephone numbers, employee work schedule, Admission agreement, Medication Administration Records (MAR), and observation logs.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

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 3

Control Number 59-AS-20240329145136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CAZADERO HOME, INC	FACILITY NUMBER: 455002659
	VISIT DATE: 08/28/2024

NARRATIVE

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Staff is withholding medication to client(s).

During the investigation process, four staff and two clients were interviewed. When LPA Benson inquired what protocol is when a client refuses medication, Staff reported, I have never had a client refuse medication. Staff reported I only sign the MAR when the medication is popped out of the blister pack. Staff reported when a client has a home visit staff make medication packets writing required medication information on the packet for the client to take with them. During record review it was discovered that none of the clients have missed any prescribed medication for the months of February and March of 2024.

Based on investigation, observations, record review(s), interviews which were conducted and recorded, we have found that the complaint is unsubstantiated.

Based on the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

Staff is locking client in client’s room for hours.

During the investigation process, four staff and two clients were interviewed. Staff reported the lock is on the inside of the client’s doors, it would be impossible to lock a client in their room. Staff reported at times I would send a client to their room to cool off after a behavior or separate clients when there is an argument. The client reported, “nobody did lock me in my room.” During the interview process none of the staff have witnessed the clients locked in their room.

Based on investigation, observations, record review(s), interviews which were conducted and recorded, we have found that the complaint is unsubstantiated.

Based on the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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Control Number 59-AS-20240329145136

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: CAZADERO HOME, INC	FACILITY NUMBER: 455002659
	VISIT DATE: 08/28/2024

NARRATIVE

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Staff is not assisting client with incontinent care.

During the investigation process, four staff and two clients were interviewed. Client physician reports were reviewed. During the report investigation it was discovered that three out of three clients don’t have bladder impairment. The client’s physician reports note that one client (C2) out of three clients are unable to bath themselves. During staff interviews four out of four staff reported that C2 would often refuse help with showering, stating I will go to my girlfriend’s house for help. Staff stated the client would not accept help to clean them up, we had to give a few prompts of encouragement until C2 would accept help.

Based on investigation, observations, record review(s), interviews which were conducted and recorded, we have found that the complaint is unsubstantiated.

Based on the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

Staff are not providing the necessary supervision to prevent clients from assaulting clients.

During the investigation process, four staff and two clients were interviewed. Client physician reports, incident reports, observation records and staff notes were reviewed. During the report investigation no record of client assaulting clients was found. During staff interviews staff reported an incident where one client threw a rock at another client in the yard, no witness if the rock hit the client. No injuries were reported. Staff reported the clients were in the back yard when incident happened. The staff reported the client that threw the rock has behaviors and is attending Creating Behavioral Educational Momentum CBEM. Staff stated the clients get irritated with each other but no hitting. Staff reported working at the facility since December and have never witnessed any physical fights. Staff stated on my first day of work I de-escalated two clients that started to fight and haven’t witnessed any other fighting.

Based on the interviews conducted the allegation is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Lauren Crocker
LICENSING EVALUATOR NAME: Sarah Benson
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2024

LIC9099 (FAS) - (06/04)

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